胃癌患者淋巴转移的预测分析

Prediction of lymph node metastasis of gastric cancer patients

目的 建立一个预测胃癌患者淋巴结转移的系统，以利于指导胃癌患者的治疗。方法分析2005年1月-2009年12月255例于北京友谊医院行胃癌根治术或姑息胃切除手术治疗的胃癌患者术后病理淋巴结是否转移，对其性别、年龄、术前体重下降、合并贫血、合并幽门梗阻、合并慢性疾病史、家族史、肿瘤位置、肿瘤大小、术前CEA单项增高、术前肿瘤标志物（CEA、AFP、CA199、CA125）1项或以上升高、术前胆碱酯酶、术前白蛋白、术前血红蛋白、术前血小板、术前尿蛋白进行Logistic回归分析。结果肿瘤大小和术前肿瘤标志物（CEA、AFP、CA199、CA125）中1项或以上升高对胃癌淋巴结转移的预测模型的ROC曲线下面积接近1，判别能力高。结论肿瘤大小、术前肿瘤标志物（CEA、AFP、CA199、CA125）是预测胃癌淋巴结转移的重要参数。肿瘤大小联合术前肿瘤标志物（CEA、AFP、CA199、CA125）升高预测淋巴结转移可以为我们开展其他工作如新辅助治疗提供参考。

Objective This study aimed to establish a prediction system of lymph node metastasis of gastric cancer patients, to facilitate guiding the treatment of patients with gastric cancer. Methods We analyzed 255 cases of gastric cancer from January 2005 to December 2009 in Beijing Friendship Hospital. They all had surgery or palliative gastrectomy and then examined pathological lymph node metastasis. Their gender, age, preoperative weight loss, anemia, pyloric obstruction, chronic disease history, family history, tumor location, tumor size, higher preoperative CEA, preoperative tumor markers （CEA, AFP, CA199, CA125 ） elevationed（ one or more）, preoperative choline esterase, preoperative albumin, preoperative hemoglobin, preoperative platelet and preoperative urinary protein were made Logistic regression analysis. Results The combination of preoperative tumor size, higher tumor markers （CEA, AFP, CA199, CA125） in one or more was possible for lymph node metastasis prediction. The area under ROC curve was about 100%, Showing high discriminant ability. Conclusions The tumor size and preoperative tumor markers （ CEA, AFP, CA199, CA125） are important predictive parameters for lymph node metastasis of gastric cancer. Tumor size combined with the preoperative tumor markers （ CEA, AFP, CA199, CA125 ） predicting lymph node metastasis can help us to carry out other work, such as neoadjuvant therapy, etc.