进展期胃癌N3分期及其亚分期在TNM分期系统中的合理性研究  

Rationality of N3 classification and its sub-classification in TNM classification system for advanced gastric cancer

作　　者：程彦龙[1] 黄锦宇[1] 朱志[1] 徐惠绵[1] 

机构地区：[1]中国医科大学附属第一医院胃肠肿瘤外科,沈阳110001

出　　处：《中华胃肠外科杂志》2016年第7期749-755,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81272718）

摘　　要：目的研究N3亚分期在UICC／AJCC第七版TNM分期系统中的合理性。方法回顾性分析1980年1月至2010年3月中国医科大学附属第一医院肿瘤外科收治并施行规范D2和D2＋胃癌根治术的610例N3期进展期胃癌患者的临床病理资料，并将患者分为N3a与N3b两个亚组，比较两组的临床病理特点；分别采用Log-rank检验和Cox比例风险模型对N3期及其亚分期患者预后进行单因素和多因素分析；采用Kaplan-Meier生存曲线计算各组术后5年生存率并进行比较。结果610例患者中，男性426例，女性184例，年龄（57±11）岁。术中共捡取淋巴结19842枚，转移9575枚（48．3％）。N3a期394例，N3b期216例。全组患者5年生存率为20．0％。对预后进行单因素分析显示，影响N3期胃癌预后的因素包括主癌灶部位（P=0．000）、癌灶大dx（P=0．003）、Borrmann分型（P=0．000）、病理类型（P=0．043）、淋巴管癌栓（P=0．000）、生长方式（P=0．019）、浸润深度（P=0．000）、胃切除范围（P=0．000）和N3亚分期（P=0．000）；进一步分组分析发现，影响N3a期进展期胃癌预后的因素包括癌灶大小（P=0．028）、浸润深度（P=0．000）和胃切除范围（P=0．002）；影响N3b期进展期胃癌预后的因素包括Borrmann分型（P=0．034）、淋巴管癌栓（P=0．002）、浸润深度（P=0．008）和胃切除范围（P=0．003）。多因素分析显示，淋巴管癌栓（P=0．009）、胃切除范围（P=0．001）、浸润深度（P=0．000）和N3亚分期（P=0．000）为N3期进展期胃癌预后的独立危险因素；胃切除范围（P=0．004）和浸润深度（P=0．001）为N3a期进展期胃癌预后的独立危险因素；淋巴管癌栓（P=0．006）和浸润深度（P=0．009）为N3b期进展期胃癌预后的独立危险因素。进一步比较发现，T2-4期胃癌中，N3a期与N3b期患者的5年生存率差异具有统计学意义（P=0．000）；其中T2N3a期与T2N3b�Objective To investigate the rationality of N3 classification and its sub-classification in the 7th UICC/AJCC TNM classification system. Methods Clinicopathological data of 610 patients with stage N3 advanced gastric cancer who underwent standard D2 and D2 ＋ radical surgery at the Department of Surgical Oncology, The First Hospital of China Medical University, from January 1980 to March 2010 were analyzed retrospectively. Patients were divided into N3a and N3b groups, and clinicopathological characteristics and prognosis were compared between N3a and N3b patients. Overall survival rate was determined using the Kaplan-Meier estimator. The log-rank test was used to identify differences between the survival curves of different groups. In multivariate analysis, Cox proportional hazard model was used to identify independent factors associated with prognosis. Results Among 610 patients, 426 were men and 184 were women, 394 were N3a and 216 were N3b, with a mean age of（57 ± 11） years old （range 23 to 83）. A total of 19 842 lymph nodes were examined, in which 9 575 nodes were positive, with the metastatic ratio of 48.3%. The 5-year overall survival rate was 20.0%. Univariate analysis of prognostic factors suggested that tumor location （P = 0.000）, tumor size （P = 0.003 ）, Borrmann type （P = 0.000）, pathologic type （P = 0.043）, lymphatic vessel invasion （P = 0.000）, growth pattern （P = 0.019）, invasion depth （P = 0.000）, resection extent （P = 0.000） and N3 sub- classification （P = 0.000） were significantly associated with the prognosis of N3 patients. Further analysis showed that tumor size （P= 0.028）, invasion depth （P = 0.000） and gastric resection extent （P = 0.002） were significantly associated with the prognosis of N3a patients, while Borrmann type （P = 0.034）, lymphatic vessel invasion （P = 0.002）, invasion depth （P = 0.008） and resection extent （P = 0.003） were significantly associated with the prognosis of N3b patients. Multivariate analysi

关 键 词：胃肿瘤 N3亚分期 临床病理特点 预后 

分 类 号：R735.2[医药卫生—肿瘤]