影响进展期胃癌淋巴结转移率分期和转移数量分期的病理因素

Pathological factors associated with staging of metastatic lymph node ratio and metastatic lymph node number in advanced gastric carcinoma

目的探讨进展期胃癌淋巴结转移率（rN）分期和转移数量（pN）分期与病理因素的关系，为合理的胃癌分期提供依据。方法回顾性分析2003年11月至2011年12月间新疆医科大学第一附属医院收治的555例进展期胃癌患者的临床病理资料，分析影响其州分期和pN分期的病理因素。结果单因素分析显示，分化程度、脉管内有无癌栓、肿瘤直径、大体形态和浸润深度与rN分期和pN分期均有关（P〈0．05）；组织学类型则与rN分期有关（P〈0．05），而与pN分期无关。Logistic回归分析显示，脉管内癌栓、肿瘤直径和浸润深度是进展期胃癌淋巴结转移的独立危险因素（均P〈0．05）。ROC曲线显示，在评估进展期胃癌淋巴结转移分期的诊断价值上，rN分期和pN分期基本一致（P〉0．05）。结论无论是从淋巴结转移率还是从转移数量上看，脉管内癌栓、肿瘤直径和浸润深度都是进展期胃癌淋巴结转移的独立危险因素。rN分期对于评价进展期胃癌淋巴结转移分期在诊断价值上与pN分期一致。

Objective To explore the association of pathologic factors with the staging of metastatic lymph node ratio （rN） and metastatic lymph node number （pN）, and to provide evidence for reasonable tumor staging in advanced gastric carcinoma （AGC）. Methods The elinicopathologieal data of 555 patients, who received radical resection for primary tumor of AGC between November 2003 and December 2011 in The First Affiliated Hospital of Xinjiang Medical University, were reviewed retrospectively. The clinicopathological factors influencing rN and pN were analyzed. Results Univariate analysis showed that differentiation degree, vascular invasion, tumor diameter, gross type and invasion depth were significantly associated with rN or pN （all P〈0.05）. Histological type was significantly associated with rN （P〈0.05）, but not with pN. Logistic regression analysis revealed that vascular invasion, tumor diameter I〉4 cm and invasion depth were independent risk factors for lymph node distant metastasis in AGC （all P〈0.05）. ROC curves showed that rN was consistent with pN in evaluating the diagnostic value of lymph node distant metastasis for tumor staging in AGC （P〉0.05）. Conclusions Vascular invasion tumor diameter 1〉 4 cm and invasion depth are independent risk factors for lymph node metastasis in AGC based on either metastatic lymph node ratio （rN） or metastatic lymph node number（pN）. The rN staging is consistent with the pN staging in evaluating the diagnostic value of metastatic lymph node for tumor staging in AGC.