中老年早期胃癌淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in middle-aged and elderly patients with early gastric cancer

目的研究中老年早期胃癌患者发生淋巴结转移的危险因素,为临床早期胃癌诊治提供参考。方法选取2015年11月至2016年11月收治的148例中老年早期胃癌患者,根据术后是否发生淋巴结转移将其分转移组(25例)和未转移组(123例),所有患者术后随访1年,采用癌症患者生活质量(QOL)量表评价两组患者生活质量。统计分析两组患者的临床病理资料,采用多因素Logistic回归分析淋巴结转移相关危险因素。结果转移组和未转移组患者在年龄、肿瘤大小、浸润深度、组织学类型、淋巴管癌栓、癌周明显异型增生等方面比较差异有统计学意义(P<0.05,P<0.01)。多因素Logistic回归分析显示,肿瘤直径>1 cm(OR=1.813)、浸润及浆膜下层(OR=1.769)、低分化(OR=2.798)、淋巴管癌栓(OR=3.834)是中老年早期胃癌患者淋巴结远处转移的危险因素,癌周明显异型增生是淋巴结转移的保护因素(OR=0.725)。术后1年随访,转移组患者QOL评分显著低于未转移组(P<0.05)。结论中老年早期胃癌患者发生淋巴结转移的危险因素较多,临床可针对性的制定措施,提高患者预后及生活质量。

Objective To investigate the risk factors of lymph node metastasis in middle-aged and elderly patients with early gastric cancer to provide reference for the diagnosis and treatment of early gastric cancer. Methods A total of 148 middle-aged and elderly patients with early gastric cancer treated from November 2015 to November 2016 year were selected and divided into metastasis group（ n = 25） and non-metastasis group（ n = 123） according to whether lymph node metastasis was present after operation. During 1-year postoperative follow-up,the quality of life was evaluated by the quality of life of cancer patients（ QOL）; the clinicopathological data of patients were statistically analyzed; multivariate logistic regression analysis was used to analyze the related risk factors of lymph node metastasis in two groups. Results There were statistical differences in age,tumor size,depth of invasion,histological type,lymphatic tumor emboli,obvious dysplasia of para-carcinoma tissues between two groups（ P〈0. 05,P〈0. 01）. Logistic multivariate analysis showed that tumor diameter more than 1 cm（ OR = 1. 813）,infiltrating to the subserous layer（ OR = 1. 769）,poorly differentiated type（ OR = 2. 798）,lymphatic tumor emboli（ OR = 3. 834） were the risk factors for lymph node metastasis,however,obvious dysplasia of paracarcinoma tissues（ OR = 0. 725） was a protective factor in middle-aged and elderly patients with early gastric cancer. QOL score in metastasis group was significantly lower than that in non-metastasis group（ P〈0. 05）. Conclusion The risk factors of lymph node metastasis are more in middle-aged and elderly patients with early gastric cancer,and the clinical measures can be targeted to improve the prognosis and quality of life.