回顾性分析未分化型早期胃癌淋巴结转移的风险  

Retrospective analysis of risky factors for lymph node metastasis in undifferentiated early gastric cancer

作　　者：陶元生 徐萍[2] 徐凯[2] 马睿锐[1] 

机构地区：[1]上海市松江区中心医院(上海交通大学附属第一人民医院松江分院)消化外科,上海201600 [2]上海市松江区中心医院(上海交通大学附属第一人民医院松江分院)消化内科,上海201600

出　　处：《中国当代医药》2016年第23期55-57,63,共4页China Modern Medicine

基　　金：上海市松江区科学技术攻关项目(2011SJGG23);上海市松江区科学技术攻关项目(QK1103);上海市科委医学引导类科技项目(114119b0100)

摘　　要：目的探讨未分化型早期胃癌淋巴结转移的风险因素,为临床治疗的选择提供指导。方法选取2009年1月~2015年9月于我院经胃癌手术切除病理最终确诊的62例未分化型早期胃癌患者的一般情况及术后病理进行回顾性分析。结果 62例患者中21例发生淋巴结转移,转移率为33.87%。单因素分析显示浸润深度、脉管肿瘤侵犯、是否合并溃疡与淋巴结转移呈显著性相关;多因素分析显示脉管肿瘤侵犯、是否合并溃疡是未分化型早癌胃癌淋巴结转移的独立危险因素。在无脉管肿瘤侵犯及无合并溃疡患者中,淋巴结转移率为5%,而在同时存在脉管侵犯及合并溃疡的患者中,淋巴结转移率为75%。结论当病灶最大直径≤2 cm,对无合并溃疡的未分化型黏膜内癌可考虑进行内镜下微创治疗,但应对切除标本行仔细的脉管浸润评估,一旦阳性应追加手术切除及淋巴结清扫。Objective To evaluate the riskyfactors for lymph node metastasis in undifferentiated early gastric cancer and to provide the direction in clinical for the choice of treatment.Methods From January 2009 to Semptember 2015,Clinicopathologic factors including age,gender,tumorsize,location,ulceration,depth of tumor invasion and vascular involvement of 62 patients who were diagnosed as undifferentiated early gastric cancer by surgery in our hospital were retrospectively analyzed.Results 21 of 62 patients were confirmed positive for lymph node metastasis.The incidence of lymph node metastasis was 33.87% in undifferentiated early gastric cancer.Single-factor analysis revealed that depth of tumor,vasculor involvementand ulceration were significantly associated with lymph node metastasis.Multivariate analysis revealed that vasculor involvementand ulceration were independent riskyfactors of lymph node metastasis.Only 5% of the patients negative for vasculor involvementand ulceration have lymph node metastasis,while 75% for patient with positive vasculorinvolvementand ulceration.Conclusion Endoscopic resection can be considered in undifferentiated intramucosal early gastric cancer less than or equal to 2 cm and without ulceration with a careful analysis of vascular involvement,and a surgery should be conducted when it is confirmed positive.

关 键 词：未分化型胃癌 早期胃癌 淋巴结转移 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]