胃癌第6组及其亚组淋巴结转移率和转移度的初步研究

Primary Study on Metastatic Rate and Metastasis of Subpyloric Lymph Nodes in Gastric Cancer

目的检测胃幽门下(第6组)及其亚组淋巴结转移情况,以探讨临床合理清扫第6组淋巴结的价值。方法回顾性分析2006年1月至2009年12月期间我院80例接受根治性手术且有完整第6组及其3个亚组淋巴结送检资料的胃癌患者的临床病理资料,以胃网膜右静脉为参照将第6组淋巴结分为第6a、6b和6c亚组,计算第6组及其亚组淋巴结转移率和转移度,并对其淋巴结转移情况与胃癌临床病理特征和其他组(第7、8a和9组)淋巴结转移情况的关系进行logistic回归分析。结果 80例胃癌患者中第6组淋巴结转移率为41.3%(33/80),转移度为26.0%(108/415)。第6a亚组淋巴结转移率为7.5%(6/80),明显低于第6b亚组(16.3%,13/80)和第6c亚组(36.3%,29/80),P<0.001;第6a、6b和6c亚组淋巴结转移度分别为25.0%(8/32)、17.6%(13/74)和28.2%(87/309),差异无统计学意义(P=0.292)。第6a亚组阳性淋巴结与T分期(P=0.042)和N分期(P=0.006)有关;第6b亚组阳性淋巴结与N分期(P=0.002)和TNM分期(P=0.013)有关;第6c亚组阳性淋巴结与肿瘤分化程度(P=0.008)、T分期(P=0.003)、N分期(P=0.000)和TNM分期(P=0.000)有关。logistic回归分析显示:第6组淋巴结转移情况与第8a组淋巴结转移(P=0.023)和N分期(P=0.002)均有关;第6a亚组淋巴结转移与第8a组淋巴结转移有关(P=0.018);第6b亚组淋巴结转移与N分期有关(P=0.005);第6c亚组淋巴结转移与第8a组淋巴结转移(P=0.016)和N分期(P=0.004)均有关。结论胃癌手术中要彻底清扫第6组淋巴结,尤其要重视第6a和6b亚组淋巴结的清扫。

Objective To explore the value on excision of subpyloric（No.6 group） lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups.Methods The clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed.Referring to the right gastroepiploic vein,the No.6 lymph nodes were divided into three subgroups（No.6a,No.6b,and No.6c subgroup）,and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7,No.8a,and No.9 lymph nodes were analyzed by logistic regression analysis.Results The metastatic rate of No.6 group lymph nodes was 41.3%（33/80） and with 26.0%（108/415） of the resected lymph nodes involved.The metastatic rate of lymph nodes in No.6a subgroup（7.5%,6/80） was significantly lower than that in No.6b（16.3%,13/80） and No.6c subgroup（36.3%,29/80）,P0.001.The metastasis of the resected lymph nodes in No.6a,No.6b,and No.6c subgroup was 25.0%（8/32）,17.6%（13/74）,and 28.2%（87/309）,respectively,and the difference was not significant（P=0.292）.The metastasis of lymph nodes in No.6a subgroup was correlated to T stage（P=0.042） and N stage（P=0.006）.The metastasis of lymph nodes in No.6b subgroup was correlated to N stage（P=0.002） and TNM stage（P=0.013）.The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor（P=0.008）,T stage（P=0.003）,N stage（P=0.000）,and TNM stage（P=0.000）.The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes（P=0.023） and N stage（P=0.002） in No.6 group,the metastasis of No.8a lymph nodes（P=0.018） in No.6a subgroup,N stage（P=0.005） in No.6b subgroup,and the metastasis of No.8a lymph nodes（P=0.016） and N stage（P=0.004） in No.6c subgroup.Conclusion Attentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery,especially for the lymph nodes of No.6a and No.6b subgroups.