早期胃癌淋巴结转移潜在危险因素分析

Potential Risk Factors of Lymph Node Metastasis with Early Gastric Cancer

目的:探讨影响早期胃癌淋巴结转移的潜在危险因素,指导胃癌淋巴结清扫术(D1或D2)的合理应用。方法:回顾性分析1995年3月—2010年6月经手术治疗的336例早期胃癌患者的临床病理资料,对影响早期胃癌淋巴结转移的潜在危险因素进行单因素及多因素分析。结果:早期胃癌淋巴结转移与性别(P=0.010)、年龄(P=0.013)、肿瘤部位(P=0.042)、有无合并溃疡(P=0.001)、浸润深度(P<0.0001)、有无脉管癌栓(P<0.0001)有关,合并有溃疡(P=0.012)、浸润至黏膜下层(P=0.008)及有脉管癌栓(P=0.001)是淋巴结转移的独立性危险因素;黏膜内癌淋巴结转移与肿瘤部位(P=0.007)及大小(P=0.010)有关,肿瘤直径>20mm(P=0.041)是黏膜内癌淋巴结转移的独立性危险因素。结论:合并有溃疡、浸润至黏膜下层及有脉管癌栓的早期胃癌患者进行手术时,建议行淋巴结清扫(D2)术;肿瘤直径>20mm黏膜内癌也要考虑行淋巴结清扫(D2)术。

Objective To analyze the potential risk factors of lymph node metastasis with early gastric cancer （EGC）and to provide references for the clearance of lymph nodes（D1 or D2）. Methods Three hundred and thirty-six patients with EGC removed surgically from Mar 1995 to Jun 2010 were analyzed retrospectively, the elinieopathologie features and lymph node metastasis were analyzed by univariate analysis and multivariate analysis. Results Univariate analysis revealed correlations between lymph node metastasis and various factors ranging from patient＇ s gender （P=0.010）, patient＇ s age （P=0.013）, location of tumor （P=0.042）, presence of an ulcer （P=0.001）, depth of invasion （P 〈0.0001） and presence of lymphatic thrombi involvement （P 〈0.0001）. However, in multivariate analysis, presence of an ulcer（P=0.012）, invasion to the submucosal （P=0.008）,and lymphatic involvement（P=0.001 ） were found to be independent risk factors. While in patients with intramucosal E GC, the tumor size （P=0.007）and location of tumor （P=0.010） were risk factors, tumor diameter〉 20 mm （P= 0.041 ） was the only independent risk factor. Conclusions In case of the Presence of an ulcer, invasion into the submucosa and vascular invasion in patients with early gastric cancer, lymph node dissection should be considered（D2）.Also in those with intramueosal cancer and the tumor diameter greater than 20 mm should be considered lymph node dissection（D2） should be considered.