淋巴结转移阴性胃癌的预后影响因素分析  

Prognostic factors of lymph node-negative metastasis gastric cancer

作　　者：孙丁[1] 徐惠绵[1] 黄锦宇[1] Sun Ding Xu Huimian Huang Jinyu(Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院肿瘤外科,沈阳110001

出　　处：《中华胃肠外科杂志》2017年第2期190-194,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81502101）

摘　　要：目的探讨淋巴结转移阴性（pN0）胃癌患者的预后影响因素。方法回顾性收集1980年5月至2012年8月期间中国医科大学附属第一医院肿瘤外科连续收治行胃癌根治术的pN0胃癌患者的临床资料。病例纳入标准：（1）病理明确诊断为胃腺癌；（2）术后病理证实为T1a-4bN0M0期胃癌；（3）淋巴结检取总数≥15枚。排除术后1月内死亡者、因其他疾病死亡者和残胃癌以及随访资料不全或失访者。对可能影响pN0期胃癌患者预后的临床因素进行单因素分析，并将有意义的变量纳入Cox比例风险回归模型中进一步行多因素分析，最终得出pN0胃癌患者的独立预后因素。随后采用同样的方法对影响pNn进展期胃癌（浸润深度≥T2）患者预后的因素进行分析。结果610例pN0胃癌患者入组，其中男性441例，女性169例，年龄19．0—83．0（56．4±11．0）岁。行D1淋巴结清扫45例，D2淋巴结清扫543例，D3淋巴结清扫22例。进展期胃癌384例。全组610例患者随访时间1-372（中位数32）月，期间死亡90例（14．8％），中位生存时间277．7（95％CI：257．6～297．8）月，术后1、3、5年生存率分别为96．5％、87．0％和83．2％。单因素分析结果显示，肿瘤直径、浸润深度、大体分型、淋巴结清扫方式、淋巴管癌栓与预后有关（均P〈0．05）。肿瘤直径〉4cm患者的5年生存率明显低于直径≤4cm者（75．6％比87．8％，P=0．000）；浸润深度T1a、T1b、T2、T3、T4期患者5年生存率分别为98．4％、92．8％、84．2％、61．0％和31．4％，差异有统计学意义（P=0．000）：大体分型中，早期胃癌患者5年生存率为96．0％，Borrmann Ⅰ～Ⅳ型胃癌5年生存率依次为100．0％、83．4％、73．7％及68．9％，差异有统计学意义（P=0．000）；淋巴结清扫D1、D2及D3患者术后5年生存率依次为100．0％、83．3％及58．7％，差异有统计学意义（P=0．0Objective To investigate the prognostic factors of patients with lymph node-negative metastasis gastric cancer （pN0）. Methods Clinicopathological data of patients with pN0 gastric cancer who underwent radical operation at the Department of Surgical Ontology, The First Hospital of China Medical University from May 1980 to August 2012 were collected and analyzed retrospectively. Inclusion criteria： （1） Patients were diagnosed as gastric adenocarcinoma; （2） Postoperative pathology confirmed Tla to 4bNOM0 gastric cancer; （3） Total number of harvested lymph node was more than 15. The patients, who died within 1 month after the operation, died of other diseases, had remnant gastric cancer, or had incomplete follow-up data, were excluded. Univariate analysis was used to analyze the clinical factors that may influence the prognosis of patients with stage pN0 gastric cancer, then, those significant variables were entered into the Cox＇s proportional hazards regression model for multivariate analysis to obtain the independent prognostic factors for patients with pN0 gastric cancer finally. Furthermore, the prognosis of patients with pN0 advanced gastric cancer （invasive depth i〉 T2） were analyzed using the same method. Results A total of 610 patients with pN0 gastric cancer were enrolled in the study, including 441 males and 169 females with age ranging from 19 to 83 （mean 56.4 ± 11.0） years, D1 lymph node dissection in 45 cases, D2 lymph node dissection in 543 cases, D3 lymph node dissection in 22 cases, and 384 cases of advanced gastric cancer. The overall followed-up was 1 to 372 （median 32） months. Ninety cases （14.8%） were dead during the follow-up. The median survival was 277.7 （95% CI：257.6 to 297.8） months, and the 1-, 3-, 5-year survival rates were 96.5%, 87%, 83.2%. Univariate analysis showed that tumor diameter, depth of invasion, gross type, lymph node dissection and lymph vessel cancer embolus were related to the prognosis （all P 〈 0.05）. The 5-year survival ra

关 键 词：胃肿瘤 淋巴结转移阴性 预后 影响因素 

分 类 号：R735.2[医药卫生—肿瘤]