胃癌患者N_2淋巴结转移和腹膜扩散的相关因素和预后分析  

Lymph node metastasis versus peritoneal dissemination in patients with gastric cancer: analysis of the correlated factors and prognosis

作　　者：王昭[1] 詹文华[1] 何裕隆[1] 蔡世荣[1] 彭俊生[1] 马晋平[1] 陈创奇[1] 陈正煊[1] 

机构地区：[1]中山大学附属第一医院胃肠胰外科,广东广州510080

出　　处：《中国普通外科杂志》2006年第9期645-649,共5页China Journal of General Surgery

基　　金：国家自然科学基金项目(30571833)。

摘　　要：目的分析淋巴结转移和腹膜扩散胃癌发病相关临床病理因素及其近远期预后,并探讨姑息性手术对预后的影响。方法查近11年间中山大学附属第一医院胃癌数据库,对其临床病理和随访结果进行分析。结果T4、淋巴结转移、肝转移、全胃癌、未分化癌、BorrmannIV型、女性性别与腹膜扩散有关;全胃癌、BorrmannIII型,T2,T3,T4,肝转移及腹膜扩散与淋巴结转移有关(P<0.05)。腹膜扩散P3组1年内生存率总体低于P1组和P2组(P<0.05);N2淋巴结转移组(N2组)术后1,3,5年内生存率总体低于N1组。胃癌腹膜扩散并N2淋巴结转移(PN2)组术后1,3,5年内生存率总体低于N2组。腹膜扩散患者姑息性切除术(PR)组1年内及N2患者PR组术后1,3年内生存率总体上高于旁路手术或喂食性造口术组和剖腹探查组(P<0.05)。结论PN2患者近远期预后比N2差;P3患者预后比P1,P2差;N2患者预后差于N1;PR可改善腹膜扩散胃癌患者的近期生存率,还可改善N2患者近、远期预后。Objective To investigate the correlated factors of peritoneal dissemination and lympah node metastasis from gastric cancer, the prognosis of patients with peritoneal dissemination and N2 lymph node metastasis, and the impact of palliative surgery on the prognosis. Methods Based on our database built from 1994 , the clinicopathologic data and the outcomes of the follow- up were analyzed respectively. Results The clinicopathologic factors correlated with peritoneal dissemination included T4, hepatic metastasis, the primary tumor involving the whole stomach, undifferentiated carcinoma, female sex and lymph node metastasis, while those correlated with lymph node metastasis included the primary tumor involving the whole stomach, Borrmann Ⅲ, T2 , T3 and T4 , hepatic metastasis and peritoneal dissemination （ P 〈 0.05 ） . The overall survival rate within 1 year postoperatively in the patients with P3 disease was lower than that in the patients with P1 and P2 disease（ P 〈 0. 05） , and the 1 - ,3 - , and 5 - year overall survival rate within 1, 3 or 5 years postoperatively in the patients with N2 disease was lower than that in the patients with N 1 disease （ P 〈 0.05 ） . The 1 - and 3 - year overall surivial rate in the patients with peritoneal dissemination （ P group ） and N2 lymph node metastasis （ PN2 group ） was lower than that in the patients with N2 lymph node metastasis （N2 group ） （P 〈 0. 05 ）. The overall survival rate within 1 year in the patients with peritoneal dissemination undergoing palliative resection （ PR ） and the 1 - and 3 - year overall survival rate in the patients with N2 lymph node metastasis undergoing PR was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy and the patients only undergoing exploratory laparotomy （ P 〈 0.05 ） . Conclusions The short- and long-term prognosis of PN2 group was poorer than that of N2 group ; the prognosis of P3 group was poorer than that of P1 and P2 group, and the prognosis o

关 键 词：胃肿瘤/病理学 淋巴转移 腹膜扩散 预后 

分 类 号：R735.2[医药卫生—肿瘤] R733.4[医药卫生—临床医学]