早期胃癌的诊断率及其临床病理特征分析

The diagnostic rate and analysis of the clinical pathological features of early gastric cancer

目的计算早期胃癌的早诊率,并分析早期胃癌的临床病理特征与淋巴结转移之间的关系。方法收集2015年1月至2017年12月就诊于西安交通大学第二附属医院的160例早期胃癌患者的临床病理资料并计算早诊率;从中选取99例行外科胃癌根治术者,以淋巴结转移与否分为淋巴结阴性组(88例)和淋巴结阳性组(11例),进行相关因素的对比分析。结果 2015年至2017年每年早诊率分别为10.23%、14.25%、12.87%,3年平均早诊率为12.40%。性别、浸润深度、分化程度与淋巴结转移显著相关(P<0.05);其中性别和浸润深度是淋巴结转移的独立危险因素(P<0.05)。性别预测淋巴结转移的AUC为0.682(95%CI:0.508~0.856);浸润深度预测淋巴结转移的AUC为0.722(95%CI:0.573~0.871);二者联合时预测淋巴结转移的AUC为0.806(95%CI:0.696~0.917),均高于单独的性别或浸润深度的AUC。女性和黏膜下层浸润为淋巴结转移的独立危险因素,二者结合时对淋巴结转移的预测价值较单独时高。结论本院早期胃癌近3年的早诊率为12%左右。女性患者、黏膜下层浸润或分化程度低的早期胃癌均易发生淋巴结转移,应谨慎行内镜下治疗。

Objective To calculate the early diagnosis rate of early gastric cancer, and to analyze the relationship between clinicopathological features of early gastric cancer and lymph node metastasis.Methods The clinical and pathological data of 160 patients with early gastric cancer who were admitted to the Second Affiliated Hospital of Xi’an Jiaotong University were collected from Jan. 2015 to Dec. 2017, and the early diagnosis rate was calculated. Then 99 patients who underwent radical gastrectomy were selected from them, according to whether there was lymph node metastasis, they were divided into lymph node negative group(88 cases) and lymph node positive group(11 cases), and the related factors were compared and analyzed.Results The early diagnosis rates in 2015-2017 were 10.23%, 14.25%, and 12.87%, respectively. The average early diagnosis rate in 3 years was 12.40%. Gender, depth of invasion, and degree of differentiation were significantly associated with lymph node metastasis(P<0.05). Gender and depth of invasion were independent risk factors for lymph node metastasis(P<0.05). The AUC for predicting lymph node metastasis by gender was 0.682(95% CI: 0.508-0.856);the AUC for predicting lymph node metastasis by depth of invasion was 0.722(95% CI: 0.573-0.871);when the two factors were combined, the AUC for predicting lymph node metastasis was 0.806(95% CI: 0.696-0.917), both higher than the AUC of individual gender or depth of invasion. Female and submucosal infiltration were independent risk factors for lymph node metastasis, and their predictive value for lymph node metastasis was higher when combined than when alone.Conclusion The early diagnosis rate of early gastric cancer is about 12% in our hospital in the past 3 years. Female patients, submucosal infiltration or low differentiation degree of early gastric cancer are prone to lymph node metastasis, which should be carefully treated under endoscopic treatment.