胃癌患者肠系膜上静脉旁淋巴结转移的危险因素及其对预后的影响

Risk factors of lymph node metastasis along superior mesenteric vein in gastric cancer patients and their impact on prognosis

目的探讨胃癌患者肠系膜上静脉旁淋巴结(第14v组淋巴结)转移的危险因素及其对预后的影响。方法回顾性分析2014年4月至2018年8月在我科行胃癌根治术且术中清扫第14v组淋巴结的214例胃癌患者资料。根据术后病理结果分为第14v组淋巴结阳性与阴性两组,比较两组患者的临床病理特征。采用多因素logistic回归分析第14v组淋巴结转移的危险因素。采用Cox比例风险回归模型分析第14v组淋巴结转移与TNMⅢ、Ⅳ期胃癌患者预后的关系。结果214例患者中有34例(15.9%)发生第14v组淋巴结转移。单因素分析结果显示患者年龄、肿瘤浸润深度、淋巴结转移程度、远处转移、TNM分期、肿瘤分化程度、肿瘤最长径、神经侵犯、脉管内癌栓与胃癌患者第14v组淋巴结转移有关(P均<0.05)。多因素logistic回归分析显示,TNM分期(OR=2.749,95%CI 1.947~3.882,P<0.01)、年龄(OR=2.773,95%CI 1.140~6.745,P=0.025)及第3组(OR=5.430,95%CI 1.643~17.949,P<0.01)、第6组(OR=10.244,95%CI 2.830~37.081,P<0.01)淋巴结转移是胃癌患者第14v组淋巴结转移的独立危险因素。多因素Cox比例风险回归分析显示,第14v组淋巴结转移是年龄≤65岁的TNMⅢ、Ⅳ期胃癌患者预后的独立危险因素(HR=4.065,95%CI 1.469~11.249,P=0.007)。结论对于TNM分期较晚尤其N分期较晚或有第3组、第6组淋巴结转移的进展期胃癌患者,建议术中清扫第14v组淋巴结。

Objective To investigate the risk factors of the superior mesenteric vein(No.14v)lymph node metastasis in gastric cancer patients and their impact on prognosis.Methods The clinical data of 214 gastric cancer patients who underwent radical gastrectomy and No.14v lymph node dissection in our department from Apr.2014 to Aug.2018 were retrospectively analyzed.The patients were divided into 2 groups(No.14v lymph node negative and positive groups)according to the postoperative pathological results,and pathological characteristics of the 2 groups were compared.The risk factors of No.14v lymph node metastasis were analyzed by multivariate logistic regression.The relationship between No.14v lymph node metastasis and the prognosis of patients with TNM stageⅢorⅣgastric cancer was analyzed by Cox proportional hazard regression model.Results No.14v lymph node metastasis occurred in 34(15.9%)patients.Univariate analysis showed that No.14v lymph node metastasis was correlated with the age,depth of tumor invasion,lymph node metastasis,distal metastasis,TNM stage,differentiation level,tumor maximum diameter,neuroinvasion and vessel invasion(all P<0.05).Multivariate logistic regression analysis showed that TNM stage(odds ratio[OR]=2.749,95%confidence interval[CI]1.947-3.882,P<0.01),age(OR=2.773,95%CI 1.140-6.745,P=0.025),and No.3(OR=5.430,95%CI 1.643-17.949,P<0.01)and No.6(OR=10.244,95%CI 2.830-37.081,P<0.01)lymph node metastases were independent risk factors for No.14v lymph node metastasis.Multivariate Cox proportional hazard regression analysis showed that No.14v lymph node metastasis was an independent risk factor for the prognosis of patients with TNM stageⅢorⅣgastric cancer with age≤65 years(hazard ratio[HR]=4.065,95%CI 1.469-11.249,P=0.007).Conclusion For advanced gastric cancer patients with late TNM stage(especially late N stage)or with No.3 and No.6 lymph node metastases,No.14v lymph node dissection is recommended during operation.