进展期远端胃癌第6组及其亚组淋巴结转移的危险因素分析

Risk factors of No.6 lynph node and its subgroup lymph nodes metastasis in cases of advanced distal gastric cancer

目的研究进展期远端胃癌幽门下(第6组)及其亚组淋巴结转移的临床危险因素。方法回顾性分析2019年1月~2020年1月海军军医大学附属长海医院胃肠外科接受远端胃癌根治术并有完整第6组及其亚组淋巴结资料的进展期胃癌患者230例,统计计算第6组及其亚组淋巴结的转移率、转移度并分析其临床危险因素。结果 230例患者中共有94例患者出现第6组淋巴结转移,转移率为40.87%(94/230),其中54例患者有6a亚组淋巴结转移,转移率为23.48%(54/230);57例患者有6i亚组淋巴结转移,转移率为24.78%(57/230);56例患者有6v亚组淋巴结转移,转移率为24.35%(56/230),3个亚组的转移率无统计学差异(P>0.05)。共清扫第6组淋巴结516枚,平均每例患者清扫第6组淋巴结(4.49±2.12)枚。其中阳性淋巴结195枚,转移度为37.79%(195/516)。共清扫第6a组淋巴结162枚,其中阳性淋巴结45枚,转移度为27.8%(45/162);共清扫第6i组淋巴结124枚,其中阳性淋巴结23枚,转移度为18.5%(23/124);共清扫第6v组淋巴结160枚,其中阳性淋巴结45枚,转移度为28.1%(45/160)。进一步分析临床危险因素发现,患者性别(P=0.03)、肿瘤直径(P=0.002)、远处转移M分期(P<0.001)、肿瘤TNM分期(P<0.001)与第6a亚组淋巴结转移有关;肿瘤直径(P=0.003)、淋巴结转移(P=0.01)、肿瘤TNM分期(P<0.001)与第6i亚组淋巴结转移有关;肿瘤直径(P=0.001)、远处转移M分期(P=0.013)和肿瘤TNM分期(P=0.023)与第6v亚组淋巴结转移有关。回归分析表明,肿瘤直径≥5 cm(P=0.015&0.019)、肿瘤TNM分期(P=0.027&0.045)是第6a和6i亚组淋巴结的独立危险因素;直径≥5 cm(P=0.025)、远处转移M分期(P=0.017)是第6v亚组淋巴结的独立危险因素。结论在可切除的进展期远端胃癌中,对于肿瘤大小≥5 cm和TNM分期较晚的患者应考虑彻底廓清第6组淋巴结及其各个亚组。

Objective To explore the risk factors of subpyloric lymph node(No.6 LN) and its subgroup lymph nodes metastasis in cases of advanced distal gastric cancer. Methods The clinical data including complete pathological information on No.6 group and its subgroups lymph nodes in 230 cases of advanced distal gastric cancer undergoing radical resection were retrospectively analyzed from January 2019 to January 2020. The metastatic rate and the metastasis of No.6 lymph nodes were calculated. And the risk factors of No.6 lynph nodes and its subgroup lynph nodes metastasis were analyzed. Results The metastatic rate of No.6 lymph node in all cases was 40.87%(94/230). And the metastatic rate of No.6 a, 6 i and 6 v lymph nodes were 23.48%(54/230), 24.78%(57/230), and 24.35%(56/230), respectively, and the difference was not significant(P>0.05). A total of 516 No.6 lymph nodes were dissected, and the average number of No.6 lymph nodes was(4.49±2.12) per patient. Among them, there were 195 positive lymph nodes, and the metasta was 37.79%(195/516). The metasta of the resected lymph nodes in No.6 a, 6 i and 6 v lymph node were 27.8%(45/162), 18.5%(23/124), and 28.1%(45/160), respectively. The metastasis of lymph nodes in No.6 a subgroup was correlated to gender(P=0.03), tumor diameter(P=0.002), distal metastasis(P<0.001), and TNM staging(P<0.001). The metastasis of lymph nodes in No.6 i subgroup was correlated to tumor diameter(P=0.003), lymph nodes metastasis(P=0.01), and TNM staging(P<0.001). The metastasis of lymph nodes in No.6 v subgroup was correlated to tumor diameter(P=0.001), distal metastasis(P=0.013) and TNM staging(P=0.023). The logistic regression analysis showed tumor diameter≥5 cm(P=0.015 & 0.019) and TNM staging(P=0.027 & 0.045) were independent prognostic factors for the metastasis of No.6 a and 6 i lymph nodes;And tumor diameter≥5 cm(P=0.025) and distant metastasis(P=0.017) were independent prognostic factors for the metastasis of No.6 v lymph nodes. Conclusion For cases of advanced distal gastric cancer, No.6 LN and its subgroup lymph nodes should be dissected thoroughly in cases of tumor diameter≥5 cm and TNM staging lately.