贲门癌淋巴结外软组织转移的临床病理特征及预后分析

Analysis of the clinicopathologic characters and prognostic impact of extranodal metastasis in gastric cardia patients

目的 探讨贲门癌淋巴结外软组织转移（EM）与各种临床病理特征的相关性及其对患者预后的影响.方法 回顾性分析2002年1月至2007年1月行根治性手术切除并经病理诊断明确的323例贲门癌患者的临床病理资料.其中男性272例,女性51例；年龄22～85岁,中位年龄63岁,分析EM阳性与患者临床病理因素的相关性及其对患者术后复发和生存的影响.结果 323例患者中有67例（20.7％）术后检出EM阳性,EM阳性与肿瘤Lauren分型、分化程度、浸润深度及淋巴结转移相关（x2 =4.647 ～27.216,P ＜0.05）.EM阳性与阴性患者的5年生存率和中位生存时间分别为12.3％、34.1％和20、39个月,5年生存率差异有统计学意义（x2=23.936,P=0.000）.多因素分析表明,肿瘤浸润深度、淋巴结转移和EM是贲门癌患者预后的独立危险因素.至随访截止,EM阳性患者的累积复发率高于EM阴性患者（59.7％比35.9％,x2=12.409,P=0.000）.分层分析显示,有淋巴结转移患者中,EM阳性患者累积复发率高于EM阴性患者（60.9％比40.0％,x2=8.410,P=0.004）,EM阳性患者5年生存率低于EM阴性患者（12.9％比30.1％,x2=12.939及P=0.000）.结论 EM是贲门癌患者独立预后因素.EM阳性患者术后复发风险高,生存时间短.

Objective To investigate the correlation between extranodal metastasis （EM） and clinicopathologic features as well as the effect of EM on the prognosis in gastric cardia patients.Methods Retrospective analysis was performed for the 323 cases with histologically proven adenocarcinoma of gastric cardia who underwent curative resection from January 2000 to January 2007.There were 272 male patients and 51 female patients with their median age of 63 （22 to 85） years.The relationship between clinicopathological features and extranodal metastasis was studied.The effects of the EM on the recurrence and survival of these patients were also analyzed.Results EM positive was detected in 67 （20.7%） of the 323 patients.The incidence of EM was correlated with tumor Lauren typing,differentiation degree,invasive depth and lymph node metastasis （x2 =4.647-27.216,P 〈 0.05）.The 5-year survival rate and media survival time between patients with EM and those without EM were 12.3%,34.1% and 20,39 months,there was a statistically significantly difference （x2 =23.936,P =0.000） in 5-year survival rate.Multivariate analysis identified that invasive depth,lymph node metustasis and EM as an independent prognostic factor of all the patients.To the last follow up,the cumulative probability of recurrence of EMpositive patients was significant higher than EM-negative patients （59.7% vs.35.9% ; x2 =12.409,P =0.000）.To study furthermore,stratified analysis showed that,in the node-positive patients,the cumulative recurrence rate of EM-positive patients was higher than EM-negative patients （60.9% vs.40.0% ; x2 =8.410,P =0.004） and the 5-year survival rate of EM-positive patients was less than the EM-negative patients （12.9% vs.30.1% ; x2 =12.939,P =0.000）,the differences were statistically significant.Conclusions EM positive is determined to be an independent prognosis factor of gastric cardia after curative resection.EM-positive patients have a high risk for recurrence and a short time to live.