淋巴结转移阳性早期胃癌的临床病理特征及淋巴结清扫范围对患者预后的影响

Impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer patients

目的探讨淋巴结转移阳性早期胃癌的临床病理特征及淋巴结清扫范围对其预后的影响。方法接受根治性手术的早期胃癌患者142例，根据淋巴结转移情况分为阴性组（116例）和阳性组（26例），比较两组患者的临床病理特征，并分析不同淋巴清扫范围对早期胃癌患者预后的影响。结果阴性组和阳性组患者的性别、年龄、肿瘤大小、部位、Borrmann分型、组织类型、分化程度和癌胚抗原表达水平比较，差异均无统计学意义（均P〉0．05）。阳性组患者的TNM分期晚于阴性组，差异有统计学意义（P〈0．001）。D1与D2清扫术患者的术后住院时间、术中输血量、手术时间、淋巴结阳性数比较，差异均无统计学意义（均P〉0．05）。D1与D2清扫术患者的淋巴结清扫中位数分别4和20枚，差异有统计学意义（P〈0．001）。D1和D2清扫术患者的术后并发症发生率分别为9．5％和3．3％，差异无统计学意义（P=0．128）。阴性组和阳性组患者的中位生存时间分别为156和96个月，差异有统计学意义（P=0．010）。D2和Dl淋巴结清扫术患者的中位生存时间分别为156和96个月，差异有统计学意义（P=0．0022）；阳性组中1）2和Dl清扫术患者的中位生存时间分别为96和27个月，差异有统计学意义（P=0．001）。Cox回归分析结果显示，淋巴结清扫范围、淋巴结转移为早期胃癌的独立预后因素。结论术前仅根据常规临床病理特征无法准确评估早期胃癌的淋巴结转移状况，对淋巴结转移状况不明者应采取D2清扫术；与D1清扫术比较，D2清扫术并不增加手术创伤和并发症，但患者预后显著改善。

Objective To explore the impact of clinicopathological features and extent of lymph node dissection on the prognosis in early gastric cancer （EGC） patients. Methods A total of 142 EGC cases screened from database of gastric cancer of Sun Yat-sen University, from Aug. 1994 to Jan. 2010, were included in this study. According to the lymph node metastasis status, they were divided into lymph node negative （n = 116） and lymph node positive （n = 26） groups. The clinicopathological features of the two groups and the impact of extent of lymph node dissection on the prognosis were analyzed. Results There were no significant differences in age, gender, tumor size and location, Borrmann typing, WHO TNM staging, histological typing, and CEA value between the two groups （ P 〉 0.05 ）. The TNM stages in the lymph node positive group were higher than that in the lymph node negative group （P 〈 0. 001 ）. Between the cases who underwent D1 （n =21 ） and D2 （n--121 ） dissection, there were no significant differences in postoperative hospital days, blood transfusion volume, and operation time （P 〉 0.05 ）. The median numbers of LN dissected in D1 and D2 cases were d （0 to 16） and 20 （ 12 to 30）, with a significant difference （P = 0. 000）, but the number of positive LN without significant difference （ P = 0. 502 ）. The postoperative complication rates were 9.5% in the D1 and 3.3% in the D2 dissection groups, without a significant difference （P = 0. 128）. The median survival time of the lymph node negative and positive groups was 156 vs. 96 months （P =0.010）. In cases who received D2 and D1 lymph node dissection, the median survival time （MST） was 156 vs. 96 months （P =0. 0022）. In the lymph node positive group, D2 dissection prolonged survival time significantly than D1 dissection （96 vs. 27months） （P --0. 001 ）. Cox regression analysis showed that the extent of lymph node dissection and LN metastasis were independent prognostic factors for EGC patients. Conclusions It is not able to accurately assess the LN metastasis status preoperatively according to the routine clinicopathological features. For the patients with unknown LN metastasis status, D2 dissection should be the first choice. Comparing with D1 dissection, the morbidity of D2 dissection are not increased, but survival time is prolonged.