进展期胃癌门静脉后淋巴结转移危险因素的临床分析

Clinical analysis of the risk factors for No.12p LN metastasis in advanced gastric cancer

目的探讨分析进展期胃癌门静脉后淋巴结（No.12p淋巴结）转移的危险因素。方法回顾性分析自2005年1月至2010年12月福建省立医院收治的183例进展期胃癌的临床病理资料，183例病例均进行标准D2淋巴结清扫＋门静脉后淋巴结清扫，对No.12p淋巴结转移潜在影响因素进行统计学分析。结果 18例（9.8%）存在No.12p淋巴结转移，Logistics回归分析显示Borrmann分型（Ⅲ/Ⅳ与Ⅰ/Ⅱ，P＝0.008），肿瘤大小（≥6 cm与〈6 cm，P＝0.001），浸润深度（pT4与pT2/pT3，P＝0.049）对No.12p淋巴结转移风险比分别呈9.5倍，8.5倍及3.2倍增加。Logistics回归分析还显示No.5（P＝0.002），No.12a（P＝0.002）对No.12p淋巴结转移风险分别呈7.5倍及7.3倍增加，另外No.12p淋巴结转移阳性与No.12p淋巴结转移阴性患者的5年生存率差异有统计学意义（11.1%与32.7%，P＝0.042）。结论Borrmann分型、肿瘤大小、浸润深度是判断No.12p淋巴结转移的重要因素；No.5淋巴结及No.12a淋巴结转移阳性提示No.12p淋巴结转移的可能性大。

Objective To analyse the risk factors for periportal lymphnode （No.12p LN） in advanced gastric cancer.Methods A retrospective analysis of 183 patients with advanced gastric cancer from January 2005 to December 2010, and all patients were underwent D2 lymphadenectomy in addition to No. 12p LN dissections. Potential clinicopathological factors that could influence No. 12p LN metastasis were statistically analyzed.Results There were 18 cases （9.8%） with periportal lymphnode metastasis. A logistic regression analysis suggested that the Borrmann type （Ⅲ/Ⅳ versus Ⅰ/Ⅱ, P=0.008）, tumor size （≥6 cm vs 〈6 cm, P=0.001）, and depth of invasion （pT4 vs pT2/pT3, P=0.049） were associated with 9.5-, 8.5-, and 3.2-fold increases, respectively, for risk of No. 12p LN metastasis. A logistic regression analysis also showed that No. 5 （P=0.002） and No. 12a （P=0.002） LN metastasis were associated with 7.5- and 7.3-fold increases, respectively, for risk of No. 12p LN metastasis. In addition, significant differences in 5-year survival of patients with and without No. 12p LN metastasis were observed （11.1% vs 32.7%, P=0.042）.Conclusions Borrmann type, tumor size and depth of invasion are significant factors for identifying patients with No. 12p LN metastasis. Patients with No. 5 or No. 12a LN metastasis should be higher possibility of No.12p LN metastasis.