早期胃癌淋巴结转移规律的临床病理因素研究

Clinicopathological factors for lymph node metastasis in early gastric cancer

目的探讨早期胃癌临床病理因素与淋巴结转移规律的相关性。方法回顾性分析2012年1月—2018年12月期间在陆军军医大学第一附属医院经胃镜下活检病理确诊,并实施外科根治手术的早期胃癌病例,采用单因素分析及Logistic回归多因素分析相关临床病理因素与各组淋巴结转移的关系。结果164例早期癌患者中,34例出现转移。单因素分析显示病理分化程度、浸润深度、肿瘤最大径、脉管浸润与早期胃癌淋巴结转移相关(P均<0.05)。Logistic回归多因素分析结果显示:肿瘤最大径>2 cm(OR=3.2,95%CI:2.305~4.187)、浸润至黏膜下层(OR=2.5,95%CI:2.091~3.859)、病理分化不良(OR=1.7,95%CI:1.029~2.933)及脉管侵犯(OR=2.1,95%CI:1.817~3.176)是早期胃癌淋巴结转移的独立影响因素(P均<0.05)。上部癌中转移率较高的淋巴结依次是第1组(66.7%)、第3组(33.3%);中部癌中转移率较高的淋巴结依次是第3组(75.0%)、第4组(25.0%);下部癌中转移率较高的淋巴结依次是第6组(33.3%)、第3组(25.9%)、第4组(25.9%)及第7组(14.8%)。从转移站别看,分化良好且肿瘤直径≤2 cm的黏膜内早期癌,各部位癌第1站均未见淋巴结转移。结论早期胃癌肿瘤最大径>2 cm﹑浸润至黏膜下层﹑病理分化程度低及脉管受侵犯是淋巴结转移的危险因素。上、中、下部癌均有其各自的高发区域,早期胃癌的淋巴结胃周转移基本符合由近及远的规律。

Objective To explore the correlationship of clinicopathological factors and lymph node metastasis(LNM)in early gastric cancer(EGC).Methods Data of 164 patients diagnosed as EGC by endoscopic biopsy who underwent D2 radical gastrectomy at the First Affiliated Hospital of Army Military Medical University from January 2012 to December 2018 were retrospectively studied.The correlation between the clinicopathological factors and the presence of LNM was analyzed with univariate analysis and multivariate logistic regression.Results Of the 164 patients,34 cases had LNM.Univariate analysis showed that tumor size,depth of invasion,histopathologic type and vessel involvement were markedly associated with a higher rate of LNM(all P<0.05).Logistic regression multivariate analysis showed that tumor maximal diameter>2 cm(OR=3.2,95%CI:2.305-4.187),invasion of submucosa(OR=2.5,95%CI:2.091-3.859),poor histological differentiation(OR=1.7,95%CI:1.029-2.933),and vessel involvement(OR=2.1,95%CI:1.817-3.176)were significantly associated with a higher rate of LNM(P<0.05).The highest frequency of LNM at upper EGC was 66.7%in Group No.1,and 33.3%in Group No.3.The highest frequency of LNM at middle EGC was 75.0%in Group No.3,and 25.0%in Group No.4,and the highest frequency of LNM at lower EGC was 33.3%in Group No.6,25.9%in Group No.3,25.9%in Group No.4,and 14.8%in Group No.7.No metastasis was seen at the first stop of early cancer within mucosa which was well-differentiated and diameter≤2 cm.Conclusion Tumor maximal diameter>2 cm,invasion of submucosa,poor histological differentiation,and vessel involvement are risk factors of LNM in EGC.Distribution of LNM is clearly related to the location of cancer.And LNM in EGC shows a proximal-to-distal metastatic pattern.