早期胃癌淋巴结转移与临床病理因素关系的临床研究

Clinical investigation of associations between early lymphatic metastasis of gastric cancer and pathological features

目的探讨早期胃癌淋巴结转移规律,为合理选择治疗方案提供参考。方法选择2005年10月至2011年10月间收治271例早期胃癌手术患者。结果单因素分析及多因素分析结果均提示,肿瘤大小、病理学分类及浸润深度与淋巴结转移密切相关。通过对淋巴结转移率的进一步分析发现,当肿瘤浸润至黏膜层时,对于<3.0cm且病理学分类为分化型的患者并未出现淋巴结转移;同样在<2.0cm病理学分类为未分化型的患者中也未出现淋巴结转移;而当肿瘤浸润至黏膜下层时,所有分类中均存在淋巴结转移。结论建议早期胃癌患者通过术前超声胃镜及病理筛选选择合适的手术方式,并严格把握内镜切除术治疗指征。

Objective To investigate the rule of lymph node metastasis in early gastric cancer （EGC） so as to provide a reasonable treatment. Methods We retrospectively analyzed the clinical data of 271 EGC patients who had been treated from October 2005 to October 2011. Results Both univariate analysis and multivariate analysis showed that tumor size, pathological classification and depth of invasion correlated with lymph node metastasis. Further analysis of the rate of lymph node metastasis showed that lymph node metastasis could not be found in patients with a differentiated tumor of less than 3.0 cm, or a tumor invading only the mucous layer. Thus lymph node metastasis could not be found in patients with an undifferentiated tumor of less than 2.0 cm. However, lymph node metastasis occurred if the tumor invaded the submucous layer. Conclusions Patients with early gastric cancer are recommended to undergo a preoperative endoscopic ultrasonographic （EUS） scan or pathological screenings for the most appropriate surgical treatment. The indications of endoscopic excision should be followed rigidly.