未分化型早期胃癌淋巴结转移的影响因素分析

Risk Factors of Lymph Node Metastasis in Undifferentiated Early Gastric Cancer

[目的]研究未分化型早期胃癌临床病理特征、血清肿瘤标志物与胃癌淋巴结转移的相关性。[方法]选择接受胃癌根治术并经术后病理诊断为未分化型早期胃癌患者80例,分析内镜特征、临床病理特征、术前血清肿瘤标志物与胃癌淋巴结转移的相关性。[结果] 80例患者中,18例有淋巴结转移。有淋巴结转移组患者黏膜下癌比例、有脉管浸润比例、血清G-17含量均明显高于无淋巴结转移组患者,血清PG-Ⅱ/PG-Ⅰ比值明显低于无淋巴结转移组患者,差异均有统计学意义(P均<0.05)。Logistics回归分析显示,黏膜下癌(OR=1.944,95%CI:1.452~2.853)、脉管浸润(OR=1.775,95%CI:1.378~2.512)、术前血清G-17升高(OR=1.661,95%CI:1.277~2.451)及PG-Ⅱ/PG-Ⅰ比值降低(OR=2.039,95%CI:1.503~2.849)是未分化型早期胃癌淋巴结转移的独立危险因素。[结论]黏膜下癌、脉管浸润、术前血清G-17升高及PG-Ⅱ/PG-Ⅰ比值降低可能增加未分化型早期胃癌淋巴结转移的风险。

[Objective] To investigate the risk factors of lymph node metastasis in undifferentiated early gastric cancer. [Methods] Eighty patients with undifferentiated early gastric cancer who underwent radical gastrectomy were enrolled in the study. The association of endoscopic findings, clinicopathological features,preoperative serum tumor markers with lymph node metastasis of gastric cancer were analyzed. [Results] Of the 80 undifferentiated early gastric cancer patients, 18 had lymph node metastasis. The submucosal cancer proportion, vascular invasion proportion and preoperative serum G-17 levels in patients with lymph node metastasis were significantly higher, while the ratio of PG-Ⅱ/PG-Ⅰ was significantly lower than those in patients without lymph node metastasis(all P<0.05). Logistic regression analysis showed that submucosal cancer(OR=1.944, 95%CI: 1.452~2.853), vascular invasion(OR=1.775, 95%CI: 1.378~2.512), elevated preoperative serum G-17(OR=1.661, 95%CI: 1.277~2.451) and decreased ratio of PG-Ⅱ/PG-Ⅰ(OR=2.039, 95%CI:1.503~2.849) were independent risk factors for lymph node metastasis of undifferentiated early gastric cancer.[Conclusion] Submucosal cancer, vascular invasion, elevated serum G-17 and decreased PG-Ⅱ/PG-Ⅰ ratio may increase the risk of lymph node metastasis in undifferentiated early gastric cancer.