淋巴结转移率对胃癌D2根治术患者的预后分析  

Prognostic Analysis of Metastatic Lymph Node Ratio in Gastric Cancer Patients with D2 Radical Gastrectomy

作　　者：黎焕君[1] 刘琦[1] 陈志良[1] 赖庆君 贾筠[1] 

机构地区：[1]东莞市人民医院,广东东莞523000

出　　处：《肿瘤学杂志》2016年第4期300-304,共5页Journal of Chinese Oncology

摘　　要：[目的]探讨淋巴结转移比例(MLR)对胃癌D2根治术患者的预后价值。[方法]回顾性分析行D2胃癌根治术89例患者的临床和随访资料。以MLR>20%为界,分为高比率组与低比率组,比较这两组患者临床病理特点及预后的差别。并从准确性、均一性2个方面分别比较MLR分期与pN分期的预后价值。[结果]MLR低比率组患者较高比率组患者的组织分化好且T分期、N分期、TNM分期早。MLR低比率组术后1、3年总生存率分别为87.2%、68.6%,高比率组术后1、3年总体生存率分别为25.6%、20.4%(P<0.001)。不同pN分期及不同MLR分期患者3年累积生存率(3-YCSR)的差异均有统计学意义(P<0.001);进一步经多因素预后分析显示,pN分期和MLR分期均可作为独立预后因素(P均<0.001)。ROC曲线显示,MLR分期预测结果所对应的曲线下面积大于pN分期,但差异无统计学意义。同一pN分期中不同MLR组间3-YCSR的差异无统计学意义(P>0.05)。[结论]胃癌D2根治术后患者MLR受病理类型、T分期、N分期、TNM分期影响,MLR高比率是胃癌D2根治术患者预后不良的重要因素之一;MLR与pN是预测胃癌生存的独立因素,MLR分期评估胃癌预后的准确性、均一性与pN分期相当。[Objective] To investigate the prognostic significance of metastatic lymph node ratio（MLR） in gastric cancer patients with D2 radical gastrectomy. [Methods] The clinical and followup data of 89 patients who underwent D2 radical gastrectomy were analyzed retrospectively. Taking MLR 20% as the boundary,we divided the data into high ratio group and low ratio group,and compared the clinicopathological features and prognosis differences between the two groups.Moreover,the prognostic value of MLR staging and pN staging were analyzed from accuracy and uniformity aspect. [Results] In the case of tissue differentiation,T stage,N stage and TNM stage,MLR low ratio group was dramatically better than those in high ratio group. The 1- year and 3-year overall survival rate in MLR low ratio group wese 87.2% and 68.6%,while there were 25.6%and 20.4% in the high ratio group（P〈0.001）. Statistically differences was found in the 3-year cumulative survival rate（3-YCSR） in different pN staging and different MLR staging patients. Further multivariate analysis showed that both pN staging and MLR staging were independent factors for prognosis（P〈0.001）. ROC curve showed that the area under curve corresponding to the MLR staging prediction result was larger than that corresponding to the pN staging. But there was no statistically significant difference between them（P〉0.05）. [Conclusion] The MLR of gastric cancer patients after D2 radical gastrectomy is influented by pathological type,T stage,N stage and TNM stage. MLR high ratio is an important factor of poor prognosis for gastric cancer patients. Both MLR and pN are independent survival predictors for gastric cancer. The predicting accuracy and uniformity of MLR are the same as pN staging.

关 键 词：胃肿瘤 D2根治性手术 淋巴结转移比率 预后 

分 类 号：R735.2[医药卫生—肿瘤]