癌结节对胃癌患者预后及淋巴结分期的影响及其意义

The significance of tumor deposits in prognosis and lymph node staging in gastric cancer patients

目的:探讨癌结节对胃癌患者预后及淋巴结分期的影响及其意义。方法:回顾性分析2016年1至12月河北医科大学第四医院收治907例胃癌患者的临床病理资料,根据病理诊断将患者分为癌结节阳性组(121例)和癌结节阴性组(786例),分析癌结节与胃癌患者的临床病理特征及预后的关系。结果:本组907例患者中有癌结节121例。单因素分析显示,癌结节与pT分期、pN分期、pTNM分期、肿瘤直径、神经受侵、脉管受侵均有关(均 P<0.05);多因素分析显示,pT分期( P<0.001)、pN分期( P=0.002)、pTNM分期( P=0.001)、肿瘤直径( P=0.033)、神经受侵( P=0.017)、脉管受侵( P=0.011)是癌结节阳性的独立危险因素。癌结节阳性胃癌患者的预后显著差于癌结节阴性患者( χ^(2)=77.869, P<0.001)。单因素分析显示,年龄、肿瘤位置、肿瘤直径、pT分期、pN分期、pTNM分期、脉管癌栓、神经受侵、有无癌结节及癌结节数量均影响患者预后(均 P<0.05)。多因素分析显示,年龄、pT分期、pN分期、pTNM分期、神经受侵、脉管受侵、癌结节数量是影响胃癌患者预后的独立因素(均 P<0.05)。分层分析发现癌结节在N0~N3a期差异有统计学意义(均 P<0.05)。 结论:癌结节是影响胃癌患者预后的独立危险因素。

Objective To investigate the effect of tumor deposits on the prognosis and lymph node staging in patients with gastric cancer.Methods The clinicopathological data of 907 patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from Jan to Dec 2016 were retrospectively analyzed.According to the pathological diagnosis,the patients were divided into tumor deposits positive group(121 cases)and tumor deposits negative group(786 cases),and the relationship between tumor deposits and clinicopathological features and prognosis was analyzed.Results Tumor deposits were found in 121 patients among 907 cases.Univariate analysis showed that tumor deposits were correlated with pT stage,pN stage,pTNM stage,tumor diameter,nerve invasion and vascular invasion(all P<0.05).Multivariate analysis showed that pT stage(P<0.001),pN stage(P=0.002),pTNM stage(P=0.001),tumor diameter(P=0.033),nerve invasion(P=0.017),vascular invasion(P=0.011)were the independent influencing factors of positive tumor deposits.The prognosis of patients with tumor deposits was worse than those without(χ^(2)=77.869,P<0.001).By univariate analysis,age,tumor location,size,pT stage,pN stage,pTNM stage,tumor thrombus,nerve invasion,tumor deposits and number affected prognosis(all P<0.05).Multivariate analysis showed that age,pT stage,pN stage,pTNM stage,nerve invasion,vascular invasion and the number of tumor deposits were independent prognostic factors(all P<0.05).By stratified analysis tumor deposits were found to have statistical difference in N0~N3a stage(all P<0.05).Conclusion Tumor deposits is an independent risk factor affecting the prognosis of gastric cancer patients.