进展期胃癌肝十二指肠韧带淋巴结转移的危险因素及其对预后的影响

Risk Factors of Hepatoduodenal Lymph Node Metastasis in Advanced Gastric Cancer and The Impact on Prognosis

目的探讨进展期胃癌患者肝十二肠韧带淋巴结(HDLN)转移的危险因素及其对预后的影响。方法回顾性分析2011年1月至2013年12月期间安康市中心医院普外科行D2胃癌根治术及HDLN清扫术的进展期胃癌患者的临床资料,采用多因素logsitic回归分析HDLN转移的危险因素,Kaplan-Miere法比较HDLN转移患者与非HDLN转移患者和其他淋巴结转移患者术后2年生存率,COX比例风险模型分析患者死亡的危险因素。结果进展期胃癌HDLN转移的发生率为10.7%,多因素logsitic回归分析结果显示,胃体中下部肿瘤(OR=6.014,P=0.002)以及T3和T4期肿瘤(OR=5.133,P=0.021)为HDLN转移的独立危险因素。HDLN转移患者术后2年生存率为36.7%,HDLN转移患者术后2年生存率明显低于无HDLN转移患者(P=0.002),对于所有淋巴结转移的患者,HDLN转移术后2年生存率亦明显低于其他淋巴结转移患者(P=0.027)。Cox回归分析显示,低分化或未分化癌、T3和T4期肿瘤以及HDLN转移是影响进展期胃癌预后的独立危险因素(P<0.05)。结论胃体中下部肿瘤以及T3和T4期肿瘤是发生HDLN转移的独立危险因素,HDLN转移提示预后不良。

Objective To investigate the risk factors of hepatoduodenal lymph node （HDLN） metastasis in patients with advanced gastric cancer and its effect on prognosis. Methods Clinical datas of patients with advanced gastric cancer who underwent D2 radical gastrectomy for gastric cancer and HDLN dissection between Jan 2011 and Nov 2013 in department of general surgery of Ankang Central Hospital were retrospectively reviewed. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with HDLN metastasis. Survival curves were performed to compare the survival rate of patients with or without HDLN metastasis and of patients with HDLN metastasis or with other lymph node metastasis. A Cox proportional hazards model was used for the multivariate analysis of risk factors for death in advanced gastric cancer. Results The incidence of HDLN metastasis was 10.7% in patients with advanced gastric cancer. Multivariate logistic regression analyses revealed that the middle or lower stomach cancer （0R=6.014, P--0.002） and stage T3 or T4 （0R=5.133, P=0.021） were independent risk factors for HDLN metastasis. The 2-year overall survival （OS） rate was 36.7% in patients with HDLN metastasis. It was lower in patients with HDLN metastasis compared with those without （P=0.002）. Limited to node-positive patients, patients with HDLN metastasis demonstrated decreased 2-year OS rate compared with node-positive patients without HDLN metastasis （P=0.027）. Cox proportional hazard analysis identified poorly differentiated or undifferentiated cancer, stage of T3 or T4, and HDLN metastasis were independent poor prognostic factors in the patients with advanced gastric cancer （P〈0.05）. Conclusions Cancer located in the middle or lower stomach, and stage T3 or T4 were independent risk factors for HDLN metastasis in patients with advanced gastric cancer. HDLN metastasis demonstrated a poor prognosis.