转移性淋巴结阳性比率对淋巴结转移胃癌患者的预后价值研究

Significance of metastatic lymph node ratio in predicting the prognosis of patients with node-positive gastric cancer

目的 探讨转移性淋巴结阳性比率（MLNR）在预测淋巴结转移胃癌患者预后中的临床价值.方法 对2005年6月至2008年5月收治的接受D2根治术的173例淋巴结转移胃癌患者的临床病理资料进行回顾性分析.采用Kaplan-Meier法分析MLNR与5年总体生存率之间的相关性,分别采用单因素及多因素分析对MLNR的预后意义进行评估,通过绘制受试者工作特性曲线（ROC曲线）比较MLNR与淋巴结转移阳性数目在预测淋巴结转移胃癌患者预后方面的敏感性和特异性.结果 Kaplan-Meier分析表明MLNR与患者的5年总体生存率呈显著负相关（P＜0.05）；单因素分析显示,MLNR、肿瘤发生部位、浸润深度、远处转移及淋巴结转移数目均为淋巴结转移胃癌患者预后的影响因素（均为P＜0.05）；多因素分析表明,MLNR是淋巴结转移胃癌患者预后的一项独立、有效的预测指标（P＜0.05）；MLNR分期对应的ROC曲线下面积（AUC）显著高于淋巴结转移阳性数目对应的AUC（P ＜0.05）.结论 MLNR是影响淋巴结转移胃癌患者预后的一项独立、有效的预测指标,其预测效果比淋巴结转移阳性数目更为准确和客观.

Objective To investigate the prognostic significance of metastatic lymph nodes ratio （MLNR） in predicting the prognosis of patients with node-positive gastric cancer.Methods The clinical and pathological data of 173 patients with node-positive gastric cancer who underwent D2 radical gastrectomy from June 2005 to May 2008 were analyzed retrospectively.The 5-year overall survival rates（OSR） were calculated by the Kaplan-Meier method.The potentially prognostic values of MLNR were evaluated by univariate and multivariate analysis respectively.Moreover,the sensitivity and specificity of MLNR and the number of metastatic lymph nodes in patients with node-positive gastric cancer were compared by the receiver operating characteristics（ROC）analysis.Results The Kaplan-Meier analysis showed that increasing MLNR was significantly correlated with a lower 5-year OSR （P ＜ 0.05）.The univariate analysis revealed that MLNR,tumor location,depth of invasion,distant metastasis and number of metastatic lymph nodes were significantly associated with prognosis of the cases（P ＜ 0.05 for each）.The multivariate analysis indicated that MLNR was an independent and effective prognostic predictor for patients with node-positive gastric cancer（P ＜ 0.05）.The area under the curve（AUC） of MLNR was significantly larger than that of the number of metastatic lymph nodes （P ＜ 0.05）.Conclusion MLNR is an independent and effective prognostic factor for patients with node-positive gastric cancer,and the predict effect of MLNR is more accurate and objective than that of the number of metastatic lymph nodes.