进展期胃癌患者第二站淋巴结转移的相关临床病理因素及预后研究

Correlated factors and prognosis of advanced gastric carcinoma with N2 lymph node metastasis

目的探讨进展期胃癌患者第二站淋巴结(N2)转移的临床病理因素及其对预后的影响。方法回顾性分析283例进展期胃癌患者的相关临床病理资料,并对其随访结果进行整理和分析。结果进展期胃癌N2淋巴结转移与Bormann分型、肿瘤部位、胃癌直径、浸润深度、手术方式以及腹膜转移等有关(P<0.05);多因素分析显示,进展期胃癌N2淋巴结转移独立危险因素是浸润深度(P<0.01)和腹膜转移(P<0.01),N2淋巴结转移情况很大程度上决定了手术治疗方案;伴有N2淋巴结转移患者术后1、3、5年生存率分别为76%、47%和12%,而无N2淋巴结转移患者分别为98%、79%和35%,两组间生存率差异有显著性(P<0.01)。结论进展期胃癌患者伴N2淋巴结转移预示疾病预后差,恶性程度高;而浸润深度和腹膜转移是进展期胃癌N2淋巴结转移的独立危险因素。

[ Objective ] To investigate the correlated factors and prognosis of advanced gastric carcinoma with N2 lymph node metastasis. [Methods] The clinicopathological data of 283 patients of advanced gastric carcinoma were retrospectively analyzed. [Results] The N2 lymph node metastasis rate of the entire group was 81.3% （230/283）. U- nivariate analysis showed that advanced gastric carcinoma N2 lymph node metastasis was related to the Borrmann types, tumor site, gastric carcinoma diameter, infiltration, operation method, peritoneal metastases （P 〈0.05）. Multi- variate analysis revealed that the infiltration （P 〈0.01） and peritoneal metastases （P 〈0.01） were risk factors of ad- vanced gastric carcinoma with N2 lymph node metastasis. The 1-year, 3-year and 5-year survival rates in patients with N2 lymph node metastasis were 76%, 47% and 12%, which in patients without N2 lymph node metastasis were 98%, 79% and 35% respectively （P 〈0.01）. [ Conclusions] The advanced gastric carcinoma with N2 lymph node metastasis predicts the high malignancy and poor diagnosis of the tumor. The Borrmann types, tumor site, gastric carcinoma diameter, infiltration, operation method, peritoneal metastases are risk factors for advanced gastric carci- noma with N2 lymph node metastasis.