区域性淋巴结反应性增生对胃癌患者术后复发及生存的影响分析

Relationship Between Topical Reactive Lymphoid Hyperplasia and Postoperative Recurrence and Survival Time of Gastric Cancer Patients

目的初步研究区域性淋巴结反应性增生对胃癌患者术后复发及生存状态的影响。方法回顾性分析2007年1月至2009年7月期间铜陵市人民医院胃肠外科因胃癌实施国际标准化D2手术并进行术后跟踪随访患者的临床资料。根据患者术后病理检出反应性增生性淋巴结的数量,采用中位数法将随访病例分为增生组(n=18)及非增生组(n=43),采用Kaplan-Meier和log-rank法比较2组患者术后5年累积无病生存率及5年累积总生存率。结果 2组患者在年龄、性别、术后病理分期、手术方式、手术范围及术后化疗方案方面的差异均无统计学意义(P>0.05)。增生组患者的中位无病生存时间为50个月,非增生组患者的中位无病生存时间为39个月,log-rank检验比较增生组患者的5年累积无病生存率明显高于非增生组患者(66.7%比34.9%,P=0.048)。增生组和非增生组患者的中位生存时间分别为53.6个月和52.3个月,术后5年累积总生存率差异无统计学意义(72.2%比60.5%,P=0.338)。结论区域性淋巴结反应性增生一定程度上反应了胃癌患者肿瘤免疫的程度,与术后5年无病生存率有明显的相关性。

Objective To investigate the relationship between topical reactive lymphoid hyperplasia and postoperative recurrence and survival of gastric cancer patients. Methods The clinical and pathological data of gastric cancer patients who underwent D2 radical gastrectomy from January 2007 to July 2009 were retrospectively analyzed. Based on the number of reactive lymph nodes, cases were divided in to topical reactive lymphoid hyperplasia group （RLH, n=18） and non-RLH group （n=43） by using a median method. The postoperative disease-free survival （DFS） and overall survival （OS） rates of patients in different groups were compared using Kaplan-Meier method and log-rank test, respectively. Results There were no significant difference between the two groups in age, gender, pathological stage, surgical approach, extent of surgery or methods of postoperative chemotherapy （P〉0.05）. The median disease-free survival time was 50 months in RLH group, and the median disease-free survival time was 39 months in non-RLH group. DFS of patients in RLH group was significant higher than non-RLH group （66.7% vs. 34.9%, P=0.048）. The median survival time was 53.6 months and 52.3 months, respectively, in RLH group and non-RLH group. No difference was found in OS between the two groups （72.2% vs. 60.5%, P=0.338）. Conclusion Topical reactive lymphoid hyperplasia reactive the immunity of gastric cancer patients and contact postoperative DFS rate.