早期胃癌发生淋巴结转移危险因素及风险模型的建立

Risk factors and risk model of lymph node metastasis in early gastric cancer

为探讨早期胃癌(EGC)淋巴结转移危险因素,并建立EGC淋巴结转移的风险评估模型。选择2017年1月至2019年6月于南京医科大学第一附属医院行胃癌切除的172例EGC患者,年龄62(52,68)岁,通过病例系统收集患者临床资料,logistic回归分析用于确定与淋巴结转移显著相关的变量,ROC曲线及校准曲线评估风险模型。结果显示,172例EGC患者淋巴结转移率为19.19%(33/172)。肿瘤大小、浸润深度、分化程度和脉管癌栓与淋巴结转移有关(P<0.05),年龄≥60岁(OR=5.556,95%CI:1.757~17.569,P=0.004)、浸润深度(OR=4.218,95%CI:1.418~12.548,P=0.010)和脉管癌栓(OR=13.878,95%CI:4.081~47.196,P<0.001)是EGC淋巴结转移的独立危险因素。基于以上危险因素建立的风险模型,一致性指数是0.8835(95%CI:0.8188~0.9482)。校正曲线显示风险评估模型与实际结果吻合良好,提示该模型具有较高的准确度和区分度。33例发生淋巴结转移的EGC患者的最常见转移部位是第3组,其次是第4组淋巴结。因此,年龄≥60岁、发生黏膜下浸润和脉管癌栓的早期胃癌患者可能发生淋巴结转移的风险较高。

To investigate the risk factors of lymph node metastasis in early gastric cancer(EGC)and to develop a risk model for the presence of lymph node metastasis.A total of 172 EGC patients,with a median age of 62(52,68)years,who underwent gastric cancer resection in the First Affiliated Hospital of Nanjing Medical University from January 2017 to June 2019 were selected.Clinical data of the patients were collected through the case system.Logistic regression analysis was used to determine the variables significantly related to lymph node metastasis.ROC curve and calibration curve were used to evaluate the risk model.The results showed that the lymph node metastasis rate of 172 EGC patients was 19.19%(33/172).Tumor size,depth of invasion,degree of differentiation and vascular tumor thrombus were associated with lymph node metastasis(P<0.05),but age≥60 years(OR=5.556,95%CI:1.757-17.569,P=0.004),invasion depth(OR=4.218,95%CI:1.418-12.548,P=0.010)and vascular cancer embolus(OR=13.878,95%CI:4.081-47.196,P<0.001)were independent risk factors for lymph node metastasis of EGC.The consistency index of the risk model based on the above risk factors was 0.8835(95%CI:0.8188-0.9482).The calibration curve shows that the risk assessment model is in good agreement with the actual results,indicating that the model has high accuracy and discrimination.The most common site of metastasis was group 3,followed by group 4.Therefore,patients over 60 years old with submucosal invasion and vascular tumor thrombus may have a higher risk of lymph node metastasis.