早期胃癌淋巴结转移与预后影响因素分析

Influencing factors for lymph node metastasis and prognosis in early gastric cancer

目的探讨影响早期胃癌淋巴结转移与预后的因素。方法采用回顾性队列研究方法。收集2010年1月至2019年12月浙江省肿瘤医院收治的1011例早期胃癌患者的临床病理资料;男561例,女450例;年龄为(58±11)岁。患者行胃癌根治术治疗。根据患者手术标本的病理学检查结果,明确各组淋巴结转移情况。观察指标:(1)早期胃癌淋巴结转移情况。(2)早期胃癌淋巴结转移的影响因素分析。(3)早期胃癌患者预后的影响因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数或百分数表示,组间比较采用χ^(2)检验。等级资料比较,采用非参数秩和检验。单因素分析采用Log-Rank检验和Logistic回归模型。多因素分析采用Logistic逐步回归模型和COX逐步回归模型。采用Kaplan-Meier法计算生存率和绘制生存曲线,采用Log-Rank检验进行生存分析。结果(1)早期胃癌淋巴结转移情况。1011例早期胃癌患者淋巴结转移率为23.640%(239/1011),其中T1a期患者淋巴结转移率为11.883%(53/446),T1b期患者淋巴结转移率为32.920%(186/565)。239例淋巴结转移患者转移淋巴结主要集中在第一站淋巴结,第1、2、3、4、5、6、7、8、9、10组淋巴结转移分别为7、11、135、59、39、91、6、8、8、6例,同1例患者可能存在多处淋巴结转移。不同肿瘤部位淋巴结转移情况:胃上部肿瘤第2组、第3组、第5组淋巴结转移分别为4、2、1例;胃中部肿瘤第1组、第2组、第3组、第4组、第5组、第6组淋巴结转移分别为3、7、36、15、3、5例;胃下部肿瘤第1组、第3组、第4组、第5组、第6组淋巴结转移分别为4、97、44、35、86例。(2)早期胃癌淋巴结转移的影响因素分析。多因素分析结果显示:肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是早期胃癌患者淋巴结转移的独立影响因素(优势比=1.80,1.49,2.65,5.76,0.60,95%可信区间为1.29~2.50,1.11~2.00,1.81~3.88,3.87~8.59,0.48~0.76,P<0.05)。(3)早期胃癌患者预后的影响因素分析。1011例早期胃癌患者均获得术后随访,随访时间为43(0~135)个月,3年总生存率为97.32%。多因素分析结果显示:年龄>60岁、淋巴结转移是影响早期胃癌患者预后的独立危险因素(风险比=9.50,2.20,95%可信区间为3.31~27.29,1.00~4.87,P<0.05)。进一步分析结果显示:年龄>60岁与年龄≤60岁胃癌患者的3年总生存率分别为99.37%和94.66%,两者比较,差异有统计学意义(χ^(2)=25.33,P<0.05)。有淋巴结转移与无淋巴结转移患者的3年总生存率分别为95.42%和97.92%,两者比较,差异有统计学意义(χ^(2)=5.69,P<0.05)。结论早期胃癌淋巴结转移率达23.640%,肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是影响早期胃癌患者淋巴结转移的独立影响因素;年龄>60岁、淋巴结转移是影响早期胃癌预后的独立危险因素。

Objective To investigate the influencing factors for lymph node metastasis and prognosis in early gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 1011 patients with early gastric cancer who were admitted to the Zhejiang Cancer Hospital from January 2010 to December 2019 were collected.There were 561 males and 450 females,aged(58±11)years.All patients underwent radical resection of gastric cancer and the lymph node metastasis of each group was identified according to the pathological examination on patients'surgical specimens.Observation indicators:(1)lymph node metastasis in early gastric cancer;(2)influencing factors for lymph node metastasis in early gastric cancer;(3)influencing factors for prognosis in early gastric cancer.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Comparison of ordinal data was analyzed using the non‐parameter rank sum test.Univariate analysis was conducted using the Log-Rank test and Logistic regression model,and multivariate analysis was conducted using the Logistic stepwise regression model and COX step-wise regression model.The Kaplan-Meier method was used to calculate survival rate and draw survival curve,and the Log-Rank test was used for survival analysis.Results(1)Lymph node metastasis in early gastric cancer.The lymph node metastasis rate of 1011 patients with early gastric cancer was 23.640%(239/1011),in which the lymph node metastasis rate of patients with T1a stage gastric cancer was 11.883%(53/446),and the lymph node metastasis rate of patients with T1b stage gastric cancer was 32.920%(186/565).There were 239 patients with lymph node metastasis mainly concentrated in the first station,including 7 cases with No.1 lymph node metastasis,11 cases with No.2 lymph node metastasis,135 cases with No.3 lymph node metastasis,59 cases with No.4 lymph node metastasis,39 cases with No.5 lymph node metastasis,91 cases with No.6 lymph node metastasis,6 cases with No.7 lymph node metastasis,8 cases with No.8 lymph node metastasis,8 cases with No.9 lymph node metastasis and 6 cases with No.10 lymph node metastasis.Multiple lymph node metastases may exist in the same patient.For lymph node metastasis in different tumor sites,there were 4 cases,2 cases and 1 case of lymph node metastasis in the No.2,3 and 5 lymph node in patients with upper gastric cancer.There were 3 cases,7 cases,36 cases,15 cases,3 cases and 5 cases of lymph node metastasis in the No.1,2,3,4,5 and 6 lymph node in patients with middle gastric cancer.There were 4 cases,97 cases,44 cases,35 cases and 86 cases of lymph node metastasis in the No.1,3,4,5 and 6 lymph node in patients with lower gastric cancer.(2)Influencing factors for lymph node metastasis in early gastric cancer.Results of multivariate analysis showed that tumor diameter,tumor location,degree of tumor invasion,vascular thrombus,degree of tumor differentiation were independent factors influencing lymph node metastasis in early gastric cancer(odds ratio=1.80,1.49,2.65,5.76,0.60,95%confidence interval as 1.29-2.50,1.11-2.00,1.81-3.88,3.87-8.59,0.48-0.76,P<0.05).(3)Influencing factors for prognosis in early gastric cancer.All 1011 patients were followed up for 43(range,0-135)months,and the 3-year overall survival rate was 97.32%.Results of multivariate analysis showed that age>60 years and lymph node metastasis were independent risk factors influencing prognosis in early gastric cancer(hazard ratio=9.50,2.20,95%confidence interval as 3.31-27.29,1.00-4.87,P<0.05).Results of further analysis showed that the 3-year overall survival rate was 99.37%and 94.66%in patient with age>60 years and≤60 years,respectively,showing a significant difference between them(χ^(2)=25.33,P<0.05).The 3-year overall survival rate was 95.42%and 97.92%in patients with and without lymph node metastasis,respectively,showing a significant difference between them(χ^(2)=5.69,P<0.05).Conclusions The lymph node metastasis rate of early gastric cancer can reach 23.640%.Tumor diameter,tumor location,degree of tumor invasion,vascular thrombus,degree of tumor differentia-tion are independent factors influencing lymph node metastasis in early gastric cancer,age>60 years and lymph node metastasis are independent risk factors influencing prognosis.