癌结节数目及分布在淋巴结阴性胃癌患者中的预后价值

Prognostic value of the number and anatomical distribution of tumor deposits in patients with gastric cancer without lymph node metastasis

目的:探讨癌结节数目及解剖位置分布在淋巴结阴性胃癌患者中的预后价值。方法:回顾性分析2012年8月至2018年8月在皖南医学院弋矶山医院行胃癌D 2根治手术91例患者的临床资料,根据术后病理筛选淋巴结阴性并含有癌结节病例。根据癌结节数目(L1、L2、L3)和解剖位置区分[胃周组(Q1)与非胃周组(Q2)]分组。 结果:L1、L2、L3组患者3年总生存率(OS)分别为58.9%、52.1%、31.5%,各组间差异有统计学意义( χ^(2)=9.769, P=0.008)。Q1组、Q2组患者3年OS分别为58.9%、7.1%,差异有统计学意义( χ^(2)=46.310, P<0.001)。单因素分析结果显示:肿瘤大小、pT分期、癌结节数目、分布、神经、脉管侵犯情况均与预后有关(均 P<0.05)。多因素分析结果显示:肿瘤>4 cm( HR=2.460,95% CI:1.307~4.629, P=0.005)、癌结节分布(非胃周)( HR=3.959,95% CI:2.077~7.545, P<0.001)、神经浸润( HR=4.299, 95%CI:1.953~9.461, P<0.001)、pT 4( HR=2.283, 95%CI:1.250~4.171, P=0.007)是影响淋巴结阴性胃癌患者预后的独立危险因素。 结论:在淋巴结阴性胃癌中,非胃周癌结节是不良预后的独立危险因素。

Objective To explore the prognostic value of tumor deposits(TD)by number and anatomical distribution in gastric cancer(GC)patients without lymph node metastasis.Methods From Aug 2012 to Aug 2018 all 91 GC patients undergoing radical gastrectomy and without nodal metastasis at Yijishan Hospital of Wannan Medical College were enrolled in this study.Patients were divided into L1,L2,and L3 groups according to the number of TD and into Q1 and Q2 groups according to the anatomical regions of the TD.Results The 3-year overall survival(OS)rates of groups L1,L2,and L3 were 58.9%,52.1%,and 31.5%,respectively(χ^(2)=9.769,P=0.008).The 3-year OS rates of groups Q1 and Q2 were 58.9%and 7.1%(χ^(2)=46.310,P<0.001).The number of TD,their distribution,neural invasion,vascular invasion,tumor size,and pT stage were all related to prognosis by univariate analysis(all P<0.05).Tumor size>4 cm(HR=2.460,95%CI:1.307-4.629,P=0.005),distribution of TD(non-perigastric)(HR=3.959,95%CI:2.077-7.545,P<0.001),neural invasion(HR=4.299,95%CI:1.953-9.461,P<0.001),and pT4 stage(HR=2.283,95%CI:1.250-4.171,P=0.007)were independent risk factors for prognosis by multivariate analysis.Conclusion The distribution of TD(non-perigastric)is an independent risk factor for poor prognosis in gastric cancer patients after radical gastrectomy and with negative lymph node metastasis.