淋巴结清扫数对进展期G3级胃癌预后的影响分析

Impact of the number of lymph nodes dissected on the prognosis of G3 advanced gastric cancer

目的 探讨进展期低分化（G3级）胃癌预后的相关因素及淋巴结清扫数对其预后的影响.方法 回顾性分析2002年12月至2007年8月复旦大学附属中山医院收治并手术的484例进展期G3级胃癌患者的临床资料,分析年龄、肿瘤浸润深度、肿瘤部位、淋巴结清扫数、淋巴结阳性数、淋巴结转移率和脉管癌栓对患者预后的影响.结果 G3级胃癌患者清扫淋巴结数是否达到15枚对淋巴结转移数、淋巴结转移率、脉管癌栓、临床分期及5年生存率均有显著影响（均P＜0.05）;多因素预后分析显示,肿瘤浸润深度、淋巴结清扫数、淋巴结转移率和脉管癌栓是其独立的预后因素（均P＜0.05）.进展期G3级胃癌淋巴结清扫大于或等于20枚/例组患者的预后优于少于20枚/例组（P＜0.01）.结论 肿瘤浸润深度、淋巴结清扫数、淋巴结转移率和脉管癌栓是评估进展期G3级胃癌预后的重要因素,淋巴结清扫数目应至少达到20枚以保证胃癌淋巴结清扫术的质量,改善患者预后.

Objective To explore the risk factors associated with the prognosis in poorly differentiated（G3） advanced gastric cancer （AGC） and the effect of number of harvested lymph nodes on the prognosis.Methods Clinical data of 484 patients with G3 advanced gastric cancer undergoing gastrectomy combined with lymphadenectomy in Zhongshan Hospital from December 2002 to October 2007 were retrospectively analyzed.The x2 test or Fisher＇s exact probability method was used to test measurement data.Survival was calculated using Kaplan-Meier method.Clinicopathological factors such as age,invasion depth,number of harvested lymph nodes,lymph node metastasis,ratio of metastatic lymph node,lymphatic vessels involvement were analyzed using the Cox regression model.Results Number of lymph node dissected,lymph node metastasis,ratio of metastatic lymph node and lymphatic vessels involvement were significantly affected by groups of 15 lymph node dissected in G3 AGC patients （P〈0.05）.Invasion depth,number of lymph node dissected,lymph node metastasis,ratio of metastatic lymph node and lymphatic vessels involvement were significantly independent predictors of survival in G3 AGC patients （all P〈0.05）.Patients with at least 20 lymph nodes had a better survival rate than those with less than 20 （P〈0.01）.Conclusions Invasion depth,number of harvested lymph nodes,lymph node metastasis,ratio of metastatic lymph node and lymphatic vessels involvement are important factors influencing the prognosis of G3 AGC.At least 20 lymph nodes should be recommended to ensure the quality of lymphadenectomy for gastric cancer.