淋巴结转移阴性的低分化和未分化胃腺癌的预后因素分析  

Prognostic factors of low-and undifferentiated gastric cancer with negative metastasis of lymph nodes

作　　者：蒋楠[1] 邓靖宇[1] 刘勇[1] 刘宏根[1] 梁寒[1] 

机构地区：[1]天津医科大学附属肿瘤医院胃部肿瘤科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,300060

出　　处：《中华消化外科杂志》2014年第8期629-632,共4页Chinese Journal of Digestive Surgery

基　　金：国家重点基础研究发展计划（973计划）项目（2010CB529301）;天津市科技计划项目（12ZCDZSY16400）

摘　　要：目的 探讨影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素.方法 回顾性分析2002年1月至2007年12月天津医科大学附属肿瘤医院收治的270例淋巴结转移阴性的低分化和未分化胃腺癌患者的临床病理资料.患者均行胃癌根治术,其中术中淋巴结清扫数目＜15枚的患者161例、15～20枚患者53例、21 ～30枚患者33例、＞30枚患者23例.采用门诊、电话、信件等方式进行随访.随访时间截至2013年10月.采用COX模型逐步后退法进行预后因素分析.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 270例患者术后均获得随访,随访率为100.00％（270/270）,中位随访时间为63个月（2～103个月）.患者总体中位生存时间为63个月（2～103个月）,1、3、5年总体生存率分别为93.0％ 、69.5％ 、58.5％.其中161例淋巴结清扫数目＜15枚患者中位生存时间为58个月（2～103个月）,1、3、5年生存率分别为91.4％、59.3％、48.8％;53例淋巴结清扫数目15 ～ 20枚患者中位生存时间为68个月（4 ～95个月）,1、3、5年生存率分别为94.3％、84.9％、71.7％;33例淋巴结清扫数目21～ 30枚患者中位生存时间为68个月（34 ～ 94个月）,1、3、5年生存率分别为100.0％、97.0％、87.9％;23例淋巴结清扫数目＞30枚患者中位生存时间为60个月（2～84个月）,1、3、5年生存率分别为87.5％、62.5％、54.2％.不同淋巴结清扫数目患者预后比较,差异有统计学意义（x2=25.077,P＜0.05）.淋巴结清扫数目21 ～30枚患者预后优于15 ～20枚患者,差异有统计学意义（x2=3.924,P＜0.05）;淋巴结清扫数目15 ～ 20枚患者预后优于＞30枚患者,差异有统计学意义（x2=4.454,P＜0.05）;淋巴结清扫数日＞30枚患者与＜15枚患者预后比较,差异无统计学意义（x2=0.450,P＞0.05）.单因素分析结果显示：患者性别、年龄、肿瘤部位、肿瘤直径、浆膜浸润、BorrmaObjective To investigate the prognostic factors of low-and undifferentiated gastric cancer with negative metastasis of lymph nodes.Methods The clinicopathological data of 270 patients with low-and undifferentiated gastric cancer and negative metastasis of lymph nodes who were admitted to the Tianjin Cancer Hospital from January 2002 to December 2007 were retrospectively analyzed.All the patients received radical gastrectomy.One hundred and sixty-one patients had the number of lymph nodes dissected under 15,53 patients had 15-20 lymph nodes dissected,33 had 21-30 lymph nodes dissected and 23 patients with the number of lymph nodes dissected more than 30.Patients were followed up via out-patient examination,phone call and mail till October 2013.The prognosis analysis was done by COX step-wise regression.The survival curve was drawn by KaplanMeier method,and the survival was analyzed using the Log-rank test.Results All the patients were followed up for a median time of 63 months （range,2-103 months）.The median survival time was 63 months （range,2-103 months）,and the 1-,3-,5-year overall survival rates were 93.0%,69.5% and 58.5%,respectively.The median survival time of the 161 patients with the number of lymph nodes dissected under 15 was 58 months （range,2-103 months）,and the 1-,3-,5-year survival rates were 91.4%,59.3% and 48.8%,respectively.The median survival time of the 53 patients with the number of lymph nodes dissected between 15 and 20 was 68 months （range,4-95 months）,and the 1-,3-,5-year survival rates were 94.3%,84.9% and 71.7%,respectively.The median survival time of the 33 patients with the number of lymph nodes dissected between 21 and 30 was 68 months （range,34-94 months）,and the 1-,3-,5-year survival rates were 100.0%,97.0% and 87.9%,respectively.The median survival time of the 23 patients with the number of lymph nodes dissected more than 30 was 60 months （range,2-84 months）,and the 1-,3-,5-year survival rates were 87.5%,62.5% and 54.2%,respectively.There was significant diff

关 键 词：胃肿瘤 淋巴结转移 预后因素 

分 类 号：R735.2[医药卫生—肿瘤]