不同浸润深度远端胃癌的临床病理特点分析

Analysis of clinicopathological parameters for distal gastric cancer patients with different tumor invasion depth

目的总结不同T分期远端胃癌患者的临床病理特点,分析淋巴转移规律。方法回顾性分析1997年1月至2011年1月间本院数据库资料齐全的570例根治性远端胃癌患者的临床病理资料,比较不同T分期患者间淋巴结转移率和转移度的差异。结果不同T分期远端胃癌之间肿瘤大小及肿瘤分化程度差异有统计学意义(P<0.05),多因素分析显示肿瘤浸润深度与肿瘤大小是远端胃癌淋巴结转移的独立危险因素。全组570例远端胃癌患者淋巴结转移率为62.8%,其中T_1期为18%,T_2期为39.7%,T_3期为76.0%,T_4期为80.1%,进展期淋巴结总体转移率为78.1%,不同T分期患者淋巴结转移率有显著性差异。全组患者淋巴结总体转移度15.8%,其中T_1期为2.2%,T_2期为6.4%,T_3期为26.7%,T_4期为37.7%,进展期淋巴结转移度为26.9%,不同T分期患者淋巴结转移度差异有统计学意义。结论不同T分期远端胃癌的临床病理特征和淋巴转移特点不同,随T分期增高,淋巴结转移率和转移度增高。根据T分期不同,一定程度上可指导合理的淋巴清扫范围。

Objective To summarize the clinicopathological characteristics of distal gastric cancer and to explore the appropriate extent of lymph node dissection for distal gastric cancer patients based on different ration and degree of lymph node metastasis among different T category. Methods A retrospective study was carried out on 750 distal gastric cancer cases who underwent radical resection with D_2 lymph node dissection in our department from January 1997 to January 2011. The differences of ration and degree of lymph node metastasis among different T categories were compared. Results There were statistically significant differences of the degree of differentiation and tumor size among different T stage of distal gastric cancer patients（P〈0.05）. Multivariate analysis showed that the depth of tumor invasion and tumor size were the independent risk factors of lymph node metastasis in distal gastric cancer patients in our study. Among 570 included patients, the overall lymph node metastasis rate of advanced distal gastric cancer was 78.1% and the metastatic lymph node ratio was 26.9%. Conclusions There were different pattens of lymph node metastasis and clinicopathological characteristics amonng different T stages. The T sage may give a help to decide reasonable lymph node dissection area and degree.