阴性淋巴结数目在T3期胃癌预后中的价值

The value of negative lymph node count in T3 gastric cancer

目的 评价阴性淋巴结数目在T3期胃癌预后中的价值.方法 收集2003年1月至2007年12月有完整临床和随访资料的胃癌根治术T3期患者214例,采用Kaplan-Metier生存分析进行单因素分析,Log-rank比较组间差异,COX回归进行多因素分析,比较阴性淋巴结数目（negative lymph node count,NLNC）分期与pN分期及淋巴结转移率（metastatic lymph nodes ratio,MLR）分期在胃癌预后评价中的差异.结果 单因素分析表明,pN分期（x2=31.664）、MLR分期（x2=34.123）、肿瘤大小（x2=5.025） 、Borrmann分型（x2=5.401）、分化类型（x2=5.993）和NLNC分期（）x2=37.256）均与胃癌预后相关（均P ＜0.05）.COX多因素分析：pN分期-2loglikelihood值为l 336.761,HR值为1.464;MLR分期-2loglikelihood值为1 335.821,HR值为1.441;NLNC分期-2loglikelihood值为1 326.902,HR值为1.725.对于相同pN分期中不同的NLNC分期,pN分期中N0和N1期,不同的NLNC分期预后相比差异均有统计学意义（P =0.008、p=0.014）.结论 足够的阴性淋巴结清扫数目可延长进展期胃癌患者生存时间和降低早期复发风险.

Objective To evaluate negative lymph node count （NLNC） in prediction of prognosis of T3 gastric cancer after radical resection.Method 214 T3 patients of radical gastrectomy with complete clinical and follow-up data between Jan 2003 to Dec 2007 were enrolled.Survival was determined by the Kaplan-Metier method and univariate analysis was done by Log-rank test,Multivariate analysis was performed using the COX proportional hazard regression model.-2loglikelihood value and the hazard ratio （HR） value were used to compared the value of number of lymph node-negative （NLNC） staging and pN staging and lymph node metastasis rate （MLR） in gastric cancer prognosis evaluation.Results Univariate analysis showed that,pN stage （x2 =31.664）,MLR stage （x2 =34.123）,tumor size （x2 =5.025）,type of differentiation （x2 =5.993）,Borrmann classification （x2 =5.401）,NLNC stage （x2 =37.256） were related to survival （P ＜ 0.05）.COX multivariate analysis showed that-2loglikelihood of pN staging is 1 336.761,HR value is 1.464,-2loglikelihood value of MRL staging is 1 335.821,HR value is 1.441.-2loglikelihood value of NLNC staging is 1 326.902,HR value is 1.725.The N0 and N1 staging prognosis in different NLNC staging was significant （P =0.008,P =0.014）.Conclusions Sufficient number of negative lymph node prolongs survival and reduces the risk of early recurrence in advanced gastric cancer.