早期胃癌473例淋巴结转移与临床病理特征相关性分析

Correlation analysis of lymph node metastasis and its clinicopathological features in 473 cases of early gastric cancer

目的 探讨早期胃癌临床病理特征与淋巴结转移的相关性.方法 收集2006年1月至2009年6月473例早期胃癌患者的病例资料,分析患者性别、年龄、肿瘤大小、肿瘤数量、大体分型、分化程度、浸润深度、有无溃疡、有无神经侵犯、有无淋巴管癌栓等情况.采用卡方检验分析早期胃癌淋巴结转移与各临床病理特征间的关系,采用Logistic回归模型进行早期胃癌淋巴结转移独立危险因素分析.结果 473例早期胃癌患者中77例有淋巴结转移,转移率为16.3％,其中女性转移率[24.6％ （41/167）]高于男性[11.8％（36/306）],肿瘤最大径＞2cm者转移率[22.0％（39/177）]高于最大径≤2 cm者[12.8％（38/296）],隆起型者转移率[26.1％（6/23）]高于平坦型和凹陷型者[9.0％（15/167）和19.8％ （56/283）],低分化者转移率[20.4％（51/250）]高于中分化和高分化者[12.7％（23/181）和7.1％（3/42）],浸润至黏膜下层者转移率[22.9％（41/179）]高于浸润至黏膜层者[12.2％（36/294）],有淋巴管癌栓者转移率[40.7％（11/27）]高于无淋巴管癌栓者[14.8％（66/446）],差异均有统计学意义（χ^2=12.960、6.873、10.704、7.382、9.277、12.572,P均＜0.05）.采用Logistic回归模型进行多因素分析显示,女性、肿瘤最大径＞2 cm、肿瘤低分化、肿瘤浸润至黏膜下层均是早期胃癌淋巴结转移的独立危险因素（相对危险度=2.53、2.14、1.63、2.39,P均＜0.01）.结论 女性、肿瘤最大径＞2 cm、肿瘤低分化、肿瘤浸润至黏膜下层均是早期胃癌淋巴结转移的独立危险因素.

Objective To investigate the correlation between clinicopathological features and lymph node metastasis （LNM） in early gastric cancer （EGC）.Methods From January 2006 to June 2009,the clinical data of 473 patients with EGC were collected.The data of patients including gender,age,tumor size,tumor number,general classification,differentiation degree,invasion depth,ulcer in tumor,nerve invasion,and lymphatic tumor cell embolus were analyzed.Chi-square test was performed to analyze the correlation between clinicopathological features and LNM in EGC.Logistic regression analysis was used to analyze the independent risk factor of LNM in EGC.Results Among 473 patients with EGC,77 patients had LNM and the metastasis rate was 16.3%.The metastasis rate of the female patients （24.6%,41/167） was higher than that of the male （11.8 %,36/306）.The metastasis rate of the tumors with maximum diameter over 2 cm （22.0%,39/177） was higher than that of the tumors less than 2 cm （12.8%,38/296）.The metastasis rate of the elevated lesions （26.1%,6/23） was higher than that of flat and concave lesions （9.0 %,15/167;19.8%,56/283）.The metastasis rate of poorly differentiated tumors was higher than moderate differentiated and high differentiated tumors （12.7 %,23/181; 7.1%,3/42）.The metastasis rate of tumors invading into submucosa （22.9%,41/179） was higher than that of tumors invading into mucosa （12.2%,36/294）.The metastasis rate of tumors with lymphatic embolus （40.7%,11/27） was higher than that of tumors without lymphatic embolus （14.8%,66/446） and the differences were statistically significant （χ^2 =12.960,6.873,10.704,7.382,9.277 and 12.572,all P〈0.05）.The results of multifactor analyzed by Logistic regression analysis revealed that female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa were the independent risk factors of LNM in EGC （relative risk （RR）=2.53,2.14,1.63 and 2.39,all P〈0.01）.Conclusion Female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa are the independent risk factors of LNM in EGC.