早期胃癌淋巴结转移规律及其预后分析

Lymph node metastasis and prognostic analysis of early gastric cancer patients

目的探讨早期胃癌患者的临床病理特征与淋巴结转移的关系,并分析其对预后的影响。方法回顾性分析2006年1月至2015年12月间北京大学第一医院手术治疗的178例早期胃癌患者的临床病理资料,分析其淋巴结转移规律和5年生存率。结果178例早期胃癌患者共有19例发生淋巴结转移,转移率为10. 7% o单因素分析结果显示:肿瘤大小(χ^2 =4.804,P = 0.028)、浸润深度(χ^2 =8.176, P = 0. 003)、分化程度(χ^2 = 4. 333, P = 0. 037)、脉管癌栓(χ^2 = 9. 992, P = 0. 002)均与早期胃癌的淋巴结转移有关;多因素分析显示:肿瘤浸润深度(Wald =4. 954,P = 0. 026)和脉管癌栓(Wald =3. 966,/>=0.046)是早期胃癌发生淋巴结转移的独立影响因素。伴有淋巴结转移的早期胃癌患者的5年生存率为78. 9%,低于无淋巴结转移患者的94. 3%,差异有统计学意义(χ^2 =& 310,P = 0.004)。结论早期胃癌的淋巴结转移主要与肿瘤的浸润深度和脉管癌栓有关,伴有淋巴结转移早期胃癌患者的预后比无淋巴结转移早期胃癌患者的差。

Objective To investigate the correlation between clinicopathological features and lymph node metastasis in early gastric cancer ( EGC) and evaluate the influence of lymph node metastasis on the overall survival. Methods The clinicopathological data of 178 EGC patients undergoing radical gastrectomy with lymphadenectomy in Peking University First Hospital between Jan 2006 and Dec 2015 were retrospectively reviewed. The impact of lymph node metastasis on the overall survival was analyzed. Results Lymph node metastasis was detected in 19 ( 10. 7%) of 178 patients. Univariate analysis showed a positive relationship between tumor size (χ^2 = 4. 804, P = 0. 028 ), depth of invasion (χ^2 = 8. 176, P = 0. 003 ), histological type (χ^2 =4. 333 ,P = 0. 037), vascular tumor thrombus (χ^2 = 9. 992, P = 0. 002) and lymph node metastasis in EGC. Multivariate analysis revealed that depth of invasion ( Wald = 4. 954, P = 0. 026 ) and intra-vascular tumor thrombus ( Wald = 3. 966, P = 0. 046 ) were independent relative factors of lymph node metastasis in EGC patients. The 5 -year survival rates of EGC patients with lymph node metastasis were 7& 9%, much lower than that without lymph node metastasis ( 94. 3%,χ^2=8.310, P = 0. 004 ). Conclusions Lymph node metastasis in EGC is mainly correlated with depth of invasion and intra-vascular tumor thrombus. The prognosis of patients with lymph node metastasis is significantly poorer than those without lymph node metastasis.