胃下部癌No.6组淋巴结分拣特点和转移危险因素分析

Analysis of sorting characteristics and metastasis risk factors in group No.6 lymph node of lower gastric carcinoma

目的 探讨胃下部癌No.6组淋巴结分拣特点和转移危险因素,为规范腹腔镜下远端胃癌根治术淋巴结按组分拣提供支持。方法 2017年1月~2017年12月在我院胃肠外科行腹腔镜下远端胃癌D2根治术的胃下部癌病人66例。按照胃癌D2清扫范围对标本行淋巴结分拣并计算No.1、No.3、No.4sb、No.4d、No.5、No.6、No.7、No.8a、No.9、No.11p和No.12a各组分拣淋巴结总数、转移淋巴结总数、淋巴结转移的病人所占的比例和各组淋巴结转移比率。记录病人的性别、年龄、浸润深度、肿瘤直径、分化程度、神经侵犯、脉管侵犯、体质指数、HER2表达、肿瘤周围癌结节和肿瘤位置。总结No.6组淋巴结的分拣特点;单因素和多因素分析No.6组淋巴结转移的危险因素。结果 No.6组淋巴结转移的病人比例为18/66(27.3%),淋巴结转移率为60/233(25.8%);单因素分析显示,病灶浸润深度(χ~2=7.153,P=0.007)、神经侵犯(χ~2=8.503,P=0.004)、脉管侵犯(χ~2=5.677,P=0.017)、HER2表达(χ~2=4.979,P=0.026)和肿瘤周围癌结节(χ~2=5.408,P=0.020)均与No.6组淋巴结转移相关(P<0.05);No.6组淋巴结转移与No.3组(χ~2=5.432,P=0.020)、No.7组(χ~2=12.726,P=0.000)、No.8a组(χ~2=10.615,P=0.001)和No.9组淋巴结转移(χ~2=7.787,P=0.005)密切相关(P<0.05);Logistic回归进行多因素分析显示,肿瘤周围癌结节(OR=15.648,95%CI:2.946~83.118)和HER2表达(OR=11.706,95%CI:2.018~67.890)是No.6组淋巴结转移的独立危险因素(P<0.05)。结论 腹腔镜下远端胃癌根治术应重视No.6组淋巴结转移和清扫,根据No.6组淋巴结的转移情况适当扩大淋巴结的清扫范围。

Objective To investigate the characteristics of lymph node sorting and risk factors of metastasis in group No.6 lymph node of lower gastric carcinoma.To provide the data support for standardizing lymph node grouping and harvested in laparoscopic radical distal gastrectomy.Methods This study included 66 patients with lower gastric carcinoma who underwent laparoscopic D2 radical gastrectomy in the department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2017 to December 2017.Lymph node sorting of each gastric cancer sample was performed according to the scope of D2 dissection.The total number of harvested lymph nodes, total number of metastatic lymph nodes, proportion of patients with lymph node metastasis and lymph node metastasis rate were calculated in each group such as No.1、No.3、No.4 sb、No.4 d、No.5、No.6、No.7、No.8 a、No.9、No.11 p and No.12 a.Clinicopathological data were recorded: gender, age, depth of invasion, tumor size, degree of differentiation, nerve invasion, vascular invasion, body mass index, HER2 expression, cancer nodule surrounding the tumor and tumor location.The characteristics of lymph node sorting in group No.6 were analyzed and concluded.Univariate and multivariate analysis of risk factors for lymph node metastasis in group No.6 were performed.Results The proportion of patients with lymph node metastasis in group No.6 was 18/66(27.3%),and the rate of lymph node metastasis was 60/233(25.8%).Univariate analysis showed that the depth of invasion(χ~2=7.153,P=0.007),nerve invasion(χ~2=8.503,P=0.004),vascular invasion(χ~2=5.677,P=0.017),HER2 expression(χ~2=4.979,P=0.026)and cancer nodule surrounding the tumor(χ~2=5.408,P=0.020) were significantly associated with lymph node metastasis in group No.6(P< 0.05).Lymph node metastasis in group No.3(χ~2=5.432,P=0.020),group No.7(χ~2=12.726,P=0.000),group No.8 a(χ~2=10.615,P=0.001) and group No.9(χ~2=7.787,P=0.005) were closely correlated with lymph node metastasis in group No.6(P<0.05).Multivariate Logistic regression analysis showed that cancer nodule(OR=15.648,95%CI:2.946~83.118)and HER2 expression(OR=11.706,95%CI:2.018~67.890) were independent risk factors for lymph node metastasis in group No.6(P<0.05).Conclusion The attention should be paid to lymph node metastasis and sorting in group No.6 in laparoscopic radical distal gastrectomy.According to the lymph node metastasis of group No.6,the scope of lymph node dissection should be appropriately expanded.