早期胃癌淋巴结转移的多因素分析

Multivariate Analysis of Lymph Node Metastasis in Early Gastric Cancer

目的探讨早期胃癌淋巴结转移的相关因素,为早期胃癌患者治疗方案的选择提供参考。方法回顾性分析2010年1月~2016年12月186例早期胃癌在我院行胃癌根治术的临床病理资料,包括性别、年龄、肿瘤大小、肿瘤部位、有无溃疡、大体分型、组织学分型、浸润深度、肿瘤数量等。采用二元logistic回归模型分析早期胃癌淋巴结转移与临床病理特征的关系,采用logistic回归模型进行多因素分析,联合上述独立影响因素分层分析早期胃癌淋巴结转移情况。结果 186例早期胃癌的淋巴结转移率为11.8%(22/186)。单因素分析显示浸润深度(P=0.020)、组织学分型(P=0.013)、有无溃疡(P=0.013)与早期胃癌淋巴结转移显著相关。多因素logistic回归分析表明浸润至黏膜下层(OR=3.370,95%CI:1.191~9.537,P=0.022)、未分化型(OR=3.325,95%CI:1.187~9.313,P=0.022)以及合并溃疡(OR=5.202,95%CI:1.144~23.662,P=0.033)是早期胃癌发生淋巴结转移的独立影响因素,其中溃疡是作用最强的影响因素。联合上3个独立影响因素分层分析显示,分化型且不合并溃疡的早期胃癌,无论浸润深度和肿瘤大小,均未见淋巴结转移(0/41),未分化型且不合并溃疡者中仅2例出现淋巴结转移,其余各组合并溃疡的早期胃癌均有淋巴结转移。结论早期胃癌浸润至黏膜下层、未分化型以及合并溃疡均易发生淋巴结转移,其中合并溃疡时发生淋巴结转移的风险最大;分化型且不合并溃疡的早期胃癌淋巴结转移风险较低,可考虑行内镜下治疗,但术后需要密切随访。

Objective To explore the relative factors for lymph node metastasis in early gastric cancer and to provide references for the selection of treatment for early gastric cancer.Methods A total of186patients with early gastric cancer who underwent radical gastrectomy with lymphadenectomy in our hospital between January2010and December2016were retrospectively reviewed.The clinicopathological parameters included patients'gender,age,tumor size,tumor location,ulceration,macroscopic type,histological type,depth of invasion,and number of tumors.Binary logistic regression analysis was used to analyze the relationship between various clinicopathological factors and lymph node metastasis,and multivariate logistic regression analysis was further employed to identify independent relative factors for lymph node metastasis in early gastric caacer.A combination of theindependent relative factors was used to conduct the stratifying analysis of lymph node metastasis.Results In this study,lymphnode metastasis was detected in22(11.8%)of186patients.Univariate analysis showed a positive invasion(P=0.020),histological type(P=0.013),and presence of ulceration(P=0.013)and lymph node metastasis in early gastric cancer.Multivariate analysis revealed that tumor invasion to the submucosa(OR=3.370,95%Cl:1.191-9.537,P=0.022),undifferentiated type(OR=3.325,95%Cl:1.187-9.313,P=0.022),and presence of ulceration(OR=5.202,95%Cl:1.144-23.662,P=0.033)were independent relative factors of lymph node metastasis in patients with early gastric cancer.Among these independent relative factors,ulceration was the strongest influencing factor.We found no lymph node metastasis in differentiated tumors without ulcer regardless of the depth of invasion and tumor size(0/41),and there were only2cases with lymph node metastasis in undifferentiated tumors without ulccr,while other groups of patients with ulccr had a ccrtain lymph node rate.Conclusions Early gastric cancer with invasion to the submucosa,undifferentiated type,and combination with ulcer is proneto have lymph node metastasis.It shows the most probability of lymph node metastasis in tumors with ulcer.Endoscopic resection canbe considered for differentiated cancers without ulcer due to their extremely lower rate of lymph rate of lymph node metastasis,but it needs close follow-up after surgery.