进展期胃癌No．11p淋巴结转移危险因素分析

Analysis of risk factors for No.llp lymph node metastasis in advanced gastric cancer

目的探讨影响进展期胃癌No.11p淋巴结转移的危险因素。 方法回顾性分析2007年1月至2011年12月间天津医科大学肿瘤医院收治的204例进展期胃癌患者的临床病理资料。所有患者行胃癌根治术并经病理检查确诊为腺癌，术中均清扫No.11p淋巴结。记录各组淋巴结检出数目及阳性数目。单因素分析采用χ2检验，多因素分析采用二元Logistic回归模型，分析与进展期胃癌No.11p淋巴结转移有关的临床病理因素和区域淋巴结转移因素。 结果204例患者中，有29例（14.3%）存在No.11p淋巴结转移。单因素分析显示：肿瘤大小、浸润深度（T分期）和淋巴结转移（N分期）与No.11p淋巴结阳性有关（分别为χ2= 5.106，P= 0.024；χ2= 5.368，P= 0.021；χ2=25.911，P= 0.000）；区域淋巴结No.1、No.3、No.4sb、No.5、No.7和No.9阳性与No.11p淋巴结阳性有关（χ2= 4.228，P= 0.040；χ2=10.655 ，P= 0.001；χ2=17.954，P= 0.000 ；χ2=11.087，P= 0.003；χ2=15.142，P= 0.000；χ2=16.727，P= 0.000）。多因素分析证实，淋巴结N3分期（OR= 4.791, 95%CI：2.056~11.167，P= 0.000）以及No.4sb （OR= 3.498, 95%CI：1.157~10.578，P= 0.027）和No.9阳性（OR= 4.006，95%CI：1.359~11.805，P= 0.012）是No.11p淋巴结阳性的独立危险因素。 结论肿瘤N3分期以及区域淋巴结No.4sb和No.9能够较好地预测第11p组淋巴结是否转移。

ObjectiveTo investigate the risk factors for No.11p lymph node metastasis in advanced gastric cancer. MethodsA retrospective analysis was executed of the clinical data of 204 patients who were subject to advanced gastric cancer and accepted radical gastrectomy in Tianjin Cancer Hospital from January 2007 to December of 2011. All of the patients were diagnosed as gastric adenocarcinoma and received No.11p lymph node dissection. The general information of the patients and the number of dissected and positive lymph nodes were recorded in detail. Univariate and multivariate analysis of clinicopathological factors influencing No.11p lymph metastasis were performed by chi-square test and binary Logistiic Discussion , respectively. ResultsThe No.11p lymph node metastasis rate is 14.3% （29/204）in the 204 patients. The univariate analysis showed that No.11p lymph metastasis was correlated with diameter of tumor, depth of invasion （T stage）, lymph node metastasis （N stage）and TNM stage （χ2 = 5.106, χ2 = 5.368, χ2 = 25.911, P 〈 0.05）. The association between the metastasis of the regional lymph nodes No.1, No. 3, No. 4sb, No. 5, No. 7, No. 9 and No.11p was significant （χ2= 4.228, χ2= 10.655, χ2 = 17.954, χ2 = 11.087, χ2 = 15.142, χ2 = 16.727, allP 〈 0.05）. Multivariate analysis confirmed that lymph node N3 stage（OR = 4.791, 95%CI： 2.056-11.167）, No.4sb（OR = 3.498, 95%CI： 1.157-10.578）and No.9 （OR = 4.006, 95%CI： 1.359-11.805）were three independent risk factors of No.11p lymph node metastasis （all P 〈 0.05）. ConclusionThe No.11p lymph node dissection in radical gastrectomy conventionally is reasonable and necessary. Lymph node N3 stage and the metastasis of regional lymph No.4sb and No.9 are independent risk factors of the metastasis of No.11p lymph node.