早期胃癌淋巴结转移危险因素及预后分析

Risk factors of lymph node metastasis in early gastric cancer

目的探讨早期胃癌淋巴结转移的临床病理特征及危险因素。方法回顾性分析2014年1月至2019年12月期间青海大学附属医院176例确诊为早期胃癌并行根治性手术患者的临床病理资料。结果本组有24例患者发生淋巴结转移。淋巴结阴性组平均检出淋巴结个数为(23±13)枚,淋巴结阳性组平均检出淋巴结个数为(30±16)枚,差异有统计学意义(t=0.327,P=0.015)。单因素分析显示,肿瘤浸润深度(χ^(2)=3.997,P=0.046)、病理分化程度(χ^(2)=9.919,P=0.007)、脉管浸润(χ^(2)=35.145,P=0.000)、神经浸润(χ^(2)=13.343,P=0.000)均与早期胃癌淋巴结转移有关;多因素分析显示,脉管浸润(OR=16.172,95%CI 4.781~55.875)、神经浸润(OR=1.365,95%CI 1.029~14.897)、浸润深度(OR=1.859,95%CI 1.844~22.711)均是早期胃癌淋巴结转移的独立危险因素(P<0.05)。本组患者的总体3年生存率为96.6%,5年生存率为91.6%。结论早期胃癌发生淋巴结转移与肿瘤分化程度、浸润深度、脉管浸润、神经浸润及淋巴结送检数目相关。

Objective To investigate the clinical characteristics and risk factors of lymph node metastasis of early gastric cance.Methods The data of 176 early gastric cancer patients(EGC)undergoing radical gastrectomy were analyzed retrospectively.Results Lymph node(LN)metastasis occurred in 24 patients.The average harvested LN in the negative group was 23±13,and that in the positive group was 30±16,(t=0.327,P=0.015).Univariate analysis showed that there were significant differences in the depth of tumor invasion(χ^(2)=3.997,P=0.046),degree of pathological differentiation(χ^(2)=9.919,P=0.007),vascular invasion(χ^(2)=35.145,P=0.000)and nerve invasion(χ^(2)=13.343,P=0.000).Multivariate analysis showed that vascular infiltration(OR=16.172,95%CI:4.781-55.875),nerve infiltration(OR=1.365,95%CI:1.029-14.897),infiltration depth(OR=1.859,95%CI:1.844-22.711)were independent risk factors for LN metastasis in early gastric cancer(P<0.05).The overall 3-year survival rate was 96.6%,and the 5-year survival rate was 91.6%.Conclusion The lymph node metastasis of early gastric cancer is related to the degree of differentiation,the depth of invasion,vascular invasion,nerve invasion and the number of lymph node dissected.