早期胃癌淋巴结转移相关因素和淋巴结清扫范围的探讨  

Lymph node metastasis and the extent of lymph node dissection in early gastric cancer

作　　者：邹振玉[1] 沈笛[2] 邢晓伟[1] 徐建[1] 马跃[1] 王玲的 杜晓辉[1] 李荣[1] 

机构地区：[1]解放军总医院普通外科,北京100853 [2]解放军军事科学院卫生部

出　　处：《中华普通外科杂志》2016年第6期456-459,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（61170123）

摘　　要：目的探讨早期胃癌的淋巴结转移相关因素、淋巴结转移规律及预后影响因素，评价淋巴结清扫范围对患者预后的影响。方法回顾性分析2009年1月至2012年12月间在解放军总医院接受外科手术治疗的245例早期胃癌患者的临床病理资料，分析淋巴结转移规律及临床病理因素对淋巴结转移和预后的影响。结果本组245例早期胃癌患者的淋巴结转移率为17．1％，其中黏膜内癌为6．7％（9／135），黏膜下层癌为30．0％（33／110）。肿瘤最大径（P〈0．001）和浸润程度（P〈0．001）与早期胃癌淋巴结转移相关。不同部位胃癌的各站淋巴结转移率不同，胃中部癌N1转移率为15．2％，N2转移率为6．5％；胃下部癌N1转移率为15．0％，N2转移率为5．0％。生存分析显示，本组早期胃癌患者1、3、5年生存率分别为99．6％、98．7％和92．7％，肿瘤浸润程度（P=0．022）、淋巴结转移（P=0．001）和淋巴结清扫数目（P=0．043）对患者术后5年生存率有影响，淋巴结转移是影响本组早期胃癌患者术后生存的独立预后因素（P=0．035，95％叫：1．102～14．029）。结论在术前准确分期的基础上，对于肿瘤直径〉2cm的黏膜下层早期胃癌应至少行D2加第7、8a和9组淋巴结清扫术；对无法准确评估分期和淋巴结转移情况的早期胃癌应首选取淋巴结清扫术，淋巴结清扫数目应〉15枚。Objective To explore the relationship between clinicopathological characteristics and lymph node metastasis （LNM） and the regularity of LNM in early gastric cancer （EGC） , and to evaluate the influence of the extent of lymph node dissection on the prognosis of EGC patients. Methods Clinieopathological data from 245 EGC patients who underwent surgical resection at Chinese PLA General Hospital from January 2009 to December 2012 were retrospectively analyzed. Clinicopathologieal characteristics were assessed to identify the LNM regularity and significant predictive factors for LNM and overall survival Results In 42 out of 245 EGC patients （ 17. 1% ） LNM was found, and 9 （ 6. 7% ） in 135 mueosal lesions and 33 （30. 0% ） in 110 submueosal lesions. The tumor diameter （P 〈 0. 001 ） and depth of tumor infiltration （ P 〈 0. 001 ） were associated with LNM. The rate of LNM varied with tumor location. In middle stomach, the incidence of LNM was 15.2% in the first tier and 6.5% in the second tier. That in lower stomach was 15.0% and 5.0% in the first and second tier, respectively. The 1-, 3-, and 5-year overall survival rates were 99.6% , 98.7% , and 92.7% , respectively. Kaplan-Meier survival analysis indicated that depth of tumor infiltration （ P = 0. 022 ）, LNM （ P = 0. 001 ） , and the number of dissected lymph node （P = 0. 043 ） had significant effects on 5-year overall survival. Moreover, COX proportional hazards model demonstrated that LNM （P = 0. 035, 95% CI： I. 102 -14. 029） could serve as an independent prognostic predictor in EGC patients. Conclusions On the basis of accurate preoperative assessment, D1 plus No. 7, No. 8a, and No. 9 lymph node dissection should be performed for submucosal tumor measuring more than 2 cm. D2 lymph node dissection is appropriate for the tumor without accurate preoperative staging, the number of dissected lymph node should be more than 15.

关 键 词：胃肿瘤 淋巴转移 淋巴结切除术 预后 

分 类 号：R735.2[医药卫生—肿瘤]