早期胃癌淋巴结转移的危险因素:339例外科手术病例的回顾性分析

Risk factors of lymph node metastasis in early gastric cancer: a retrospective analysis of 339 cases

目的研究早期胃癌淋巴结转移(lymph node metastasis,LNM)与临床病理特征的相关性,探讨早期胃癌(early gastric cancer,EGC)淋巴结转移的危险因素。方法回顾性分析2013年1月-2015年6月于南京军区南京总医院行手术治疗的339例EGC患者,分析患者的性别、年龄、肿瘤部位、肿瘤大小、大体分型、分化程度、浸润深度、有无合并溃疡、淋巴管有无癌栓浸润等临床病理特征。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 339例EGC患者中有35例有LNM,淋巴结转移率为10.32%。单因素分析显示肿瘤大小、肿瘤浸润深度、分化程度、有无合并溃疡、淋巴管有无癌栓浸润与EGC淋巴结转移具有相关性(χ2值分别为10.734、6.241、17.694、11.694、27.656,P值均<0.05)。采用Logistic回归模型进行多因素分析显示肿瘤最大直径>2 cm、肿瘤浸润至黏膜下层、肿瘤未分化型、合并有溃疡均是早期胃癌淋巴结转移的独立危险因素(RR分别为2.063、2.743、1.706、1.552、0.195,P值均<0.05)。结论肿瘤最大直径>2 cm、肿瘤浸润至黏膜下层、肿瘤未分化型、合并溃疡均是早期LNM的独立危险因素。

Objective To investigate the correlation between lymph node metastasis （LNM） in early gastric cancer （EGC） and clinicopathological features, and to explore the risk factors of LNM in EGC. Methods A total of 339 EGC patients who underwent curative gastrectomy with lymphadenectomy in Nanjing General HosiPital of Nanjing Military Command from Jan. 2013 to Jun. 2015, were retrospectively reviewed. Clinicopathological features of patients＇ gender, age, tumor location, tumor size, macroscopic type, differentiation degree, depth of tumor invasion, ulceration and lym- phatic embolus invasion were analyzed retrospectively. Chi-square test was performed to analyze the correlation between clinicopathological features and LNM in EGC. Logistic regression analysis was taken to analyze the independent risk fac- tor of LNM in EGC. Results Among 339 patients with EGC, 35 patients had LNM, the metastasis rate was 10.32%. Univariate analysis showed tumor size, depth of invasion, differentiation degree, ulceration, lymphatic embolus were re- lated with LNM in EGC （χ2 = 10. 734, 6. 241, 17. 694, 11. 694, 27. 656, P 〈 0.05）. Logistic regression model was used for multivariate analysis and showed that tumor maximum diameter 〉 2 cm, tumor invasion to the submucosal layer, tumor undifferentiation and combined with ulceration were the independent risk factors of LNM in EGC （RR = 2. 063, 2.743, 1.076, 1.552, 0.195, P〈0.05）. Conclusion Tumor maximum diameter 〉2 cm, invasion to submucosa, undifferentiated type and combined with ulceration are the independent risk factors of LNM in EGC.