早期胃癌淋巴结转移的危险因素分析

Risk factors for lymph node metastasis in patients with early gastric cancer

目的探讨早期胃癌病人淋巴结转移的危险因素，以期为临床治疗方案的选择提供依据。方法回顾性分析我院2010年1月至2013年12月期间收治的早期胃癌病人的临床病理特征与淋巴结转移规律关系。结果共89例早期胃癌病人纳入研究分析，所有病人淋巴结转移率为14.6%（13/89）。肿瘤大体类型分为隆起型、表浅型、凹陷型，其淋巴结转移率分别为10.0%、5.6%及22.0%，各型间淋巴结转移率差异有统计学意义（P =0.000）；黏膜内癌与黏膜下癌淋巴结转移率分别为4.9%（2/41）及22.9%（11/48），二者间差异有统计学意义（P =0.016）；高分化良好型早期胃癌无淋巴结转移，中分化及低分化早期胃癌淋巴结转移分别为10.3%（3/29）、18.5%（10/54），差异有统计学意义（P =0.000）；6例病人伴有脉管癌栓，其中4例发生淋巴结转移。Logistic 回归多因素分析结果显示：肿瘤大体类型、分化程度、浸润深度及脉管癌栓对淋巴结转移具有显著性影响（P 〈0.05），其比值比（OR）值分别为4.7、3.2、15.1和5.7。病人性别、年龄、肿瘤部位等与淋巴结转移无相关性。结论早期胃癌病人淋巴结转移率低，其转移与否同肿瘤大体类型、浸润深度、分化程度以及脉管癌栓密切相关。

Objective To explore the characteristics of lymph node metastasis for patients with early gastric cancer （EGC）so as to provide theoretical rationales for selecting treatment options.Meth-ods A total of 89 EGC patients underwent surgery at our hospital from January 2010 to December 2013.And their clinicopathologic characteristics and patterns of lymph node metastasis （LNM）were analyzed retrospectively.Results Among them,13 cases （14.6%）had lymph node metastasis.The tumor macroscopic types were protuberant,superficial and depressed with lymph node metastasis rates of 10.0%,5.6% and 22.0%（P =0.000）respectively.LNM rate was 4.9%（2/41）in mucosal lesions and 22.9%（1 1/48）in submucosal lesions （P =0.016）.No lymph node metastasis was observed in well-differentiated EGC patients.And the LNM rates of moderate and poor-differentiated EGC were 10.3%（3/29）and 1 8.5%（10/54）respectively （P =0.000）.There were vascular cancer embolus （n=6）and lymph node metastasis （n=4）.Multi-factor Logistic regression analysis showed that tumor macroscopic type,degree of differentiation,depth of infiltration and vascular cancer embolus were highly correlated with lymph node metastasis （P 〈0.05）.And their odds ratios were 4.7,3.2,1 5.1 and 5.7 respectively.However,no correlation existed between patient gender,age,tumor location and lymph node metastasis.Conclusions The lymph node metastasis rate is low in EGC patients.And lymph node metastasis or not is closely correlated with tumor macroscopic type,degree of differentia-tion,depth of infiltration and vascular cancer embolus.