胃癌根治术后复发与转移的区域及规律分析

Clinical investigation of postoperative recurrence and regional lymph node metastasis of gastric cancerby CT scan

目的 通过CT诊断,分析胃癌根治术后复发与转移的区域及规律。方法 选取2009年6月至2014年6月胃癌患者共81例,均行胃癌根治性手术,随访期间CT发现存在局部区域复发或转移。分析术后复发与转移的区域及规律。用SPSS 19.0软件分析数据,以%表示计数资料,Logistic回归分析检验术后复发时间和临床病理特征和治疗之间的关系;P〈0.05,差异具有统计学意义。结果 在81例术后复发患者中,局部区域复发率最高（37.04%）,在18例伴有术后区域淋巴结转移的患者中,Ⅰ区10例,Ⅲ区3例,Ⅳ区1例,Ⅵ区4例。术后7~12个月复发率最高（41.98%）。截止至2015年9月30日,在胃癌根治术后复发的81例患者中,中位总生存时间（OS）为33.18个月,中位复发时间为19.94个月,复发后中位生存期为7.19个月。其中发生腹膜种植后,中位生存期最短,仅为4.24个月。单因素分析结果显示,与OS相关的临床病理因素包括年龄（P=0.024）,Borrmann分型（P=0.017）、TNM分期（P=0.009）、淋巴结检出总数（P=0.022）、阳性淋巴结数（P=0.002）、治疗方式（P=0.026）和治疗依从性（P=0.035）;与局部无复发生存期（LRFS）相关的临床病理因素包括淋巴结检出总数（P=0.012）、阳性淋巴结数（P=0.008）、治疗方式（P=0.034）和治疗依从性（P=0.016）。结论 局部区域复发,特别是区域淋巴结转移是胃癌根治术后复发的主要形式,术后通过CT划分淋巴结转移区域对于放疗靶区确定具有一定指导意义。

Objective To investigate the postoperative recurrence and regional lymph node metastasis of gastric cancerby CT scan . Methods From June 2009 to June 2014, 81 patients with gastric cancer underwent radical gastrectomy were enrolled into present study , all of whom were diagnosed of local recurrence or regional lymph node metastasis by CT scan during the follow-up period.Clinical data were analyzed by using SPSS 19.0 software.Count data were perented as percentage and Logistic regression analysis were performed to examine the correlation of recurrence time and clinical pathological features and treatments.A P value of ＆lt;0.05 was considered to be statistically significant difference . Results Among 81 patients, local recurrence rate was 37.04%.In 18 cases of postoperative regional lymph node metastasis , there were 10 cases of Ⅰzone, 3 cases of Ⅲ zone, 1 case of Ⅳ zone, 4 cases of Ⅵ zone.7-12 months after surgery, total recurrence rate was 41.98%.Until September 30 of 2015, the median overall survival （ OS） of 81 patients with gastric cancer recurrencewas 33.18 months, and the median time of recurrence was 19.94 months, with median survival after recurrence of 7.19 months.There was shortest median survival of 4.24 months of patients with peritoneal metastasis . Univariate analysis showed that , OS-related clinicopathological factors included age （P=0.024）, Borrmann classification （P=0.017）, N stage （P=0.009）, lymph node detection of total （P =0.022）, treatment modality （P =0.026） and treatment compliance （P =0.035）.LRFS-related clinicopathological factors, included the total number of lymph nodes detected （P =0.012）, number of positive lymph nodes （P =0.008）, treatment modality （P =0.034） and treatment compliance （P=0.016）. Conclusion Local recurrenceand regional lymph node metastasis of gastric cancer are common .CT scan could diagnose regional lymph node metastasis and could be a guidance of postoperative radiation treatment .