胃上部癌No.12a组淋巴结转移规律及生存分析

No.12a Lymph Node Metastasis and Survival Analysis of Upper Gastric Cancer

目的分析No.12a组淋巴结转移与胃上部癌临床病理特征的关系,讨论该组淋巴结的清扫适应证及其预后意义。方法回顾性分析2013年7月—2017年7月河南省人民医院胃肠外科收治的377例胃上部癌患者的病例资料。比较No.12a组淋巴结转移与临床病理特征的关系。Kaplan-Meier法对有或无No.12a组淋巴结转移患者的预后进行生存分析,Cox回归分析胃上部癌患者预后生存的影响因素。结果肿瘤位置(小弯侧)、肿瘤直径(≥5.5 cm)、分化程度、T分期、N分期、TNM分期与No.12a组淋巴结转移显著相关(P<0.05)。排除N分期后Cox回归结果显示:分化程度(HR:0.668,95%CI:0.48-0.931,P=0.017)、pTNM分期(HR:6.319,95%CI:4.063-9.828,P<0.001)是影响胃上部癌预后生存的独立危险因素,而No.12a淋巴结转移并不是胃上部癌预后生存的独立影响因素(HR:1.477,95%CI:0.71-3.075,P=0.297)。结论No.12a组淋巴结转移似乎不是胃上部癌预后的独立危险因素,但伴No.12a组淋巴结转移患者的预后比不伴No.12a组淋巴结转移的预后更差。当肿瘤位于小弯侧、分化程度为低分化、肿瘤分期较晚(T4、N3或Ⅱ-Ⅲ期)时应积极清扫No.12a组淋巴结。

Objective To analyze the relationship between No.12a lymph node metastasis and clinicopathological features of upper gastric cancer and to discuss the indications and prognostic significance of lymph node dissection in this group.Methods A retrospective analysis was performed on the medical records of 377 patients with upper gastric cancer,to compare the relationship between No.12a lymph node metastasis and clinicopathological characteristics of patients with upper gastric cancer.Kaplan-Meier method was used to analyze the prognosis of patients with or without No.12a lymph node metastasis,and Cox regression analysis was performed to analyze the influencing factors of prognosis and survival of patients with upper gastric cancer.Results Tumor location(lesser curvature side),tumor diameter(≥5.5 cm),degree of differentiation,and T/N/TNM stage were significantly correlated with No.12a lymph node metastasis(P<0.05).After excluding N staging,Cox regression results showed that the degree of differentiation(HR:0.668,95%CI:0.48-0.931,P=0.017)and pTNM stage(HR:6.319,95%CI:4.063-9.828,P<0.001)were the independent risk factors,but No.12a lymph node metastasis(HR:1.477,95%CI:0.71-3.075,P=0.297)was not an independent risk factor for survival of upper gastric cancer patients.Conclusion No.12a lymph node metastasis does not seem to be an independent risk factor for the prognosis of upper gastric cancer patients.However,the prognosis of patients with No.12a lymph node metastasis is worse than that of patients without No.12a lymph node metastasis.The No.12a lymph nodes should be actively dissected when the tumor is in the following situations:the tumor is located in the lesser curvature,the degree of differentiation is poorly differentiated,and the tumor stage is late(T4,N3,orⅡ-Ⅲstage).