影响1260例胃癌脉管癌栓形成的临床病理因素分析  

Analysis of clinicopathologic factors affecting formation of lymphovascular invasion in 1 260 patients with gastric cancer

作　　者：张殿彩[1] 李强[1] 杨力[1] 徐皓[1] 汪未知 李沣员 徐泽宽[1] 

机构地区：[1]南京医科大学第一附属医院普通外科,210029

出　　处：《中华消化外科杂志》2017年第3期269-274,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金国际合作项目（81211519）;江苏高校优势学科建设工程资助项目（IX10231801）

摘　　要：目的：分析影响胃癌患者脉管癌栓形成的相关临床病理因素。方法：采用回顾性病例对照研究方法。收集2014年1月至2015年12月南京医科大学第一附属医院收治的1 260例胃癌患者的临床病理资料。所有患者的手术标本行HE染色，并由病理学专家进行相关病理学诊断。患者肿瘤分期均采用美国癌症联合会（AJCC）和国际抗癌联盟（UICC）的第7版TNM分期标准。观察指标：（1）病理学特征：组织分化程度、浸润深度、淋巴结转移、肿瘤TNM分期。（2）随访情况。（3）脉管癌栓阳性的影响因素：分析患者性别、年龄、组织分化程度、浸润深度、淋巴结转移数目、TNM分期对胃癌脉管癌栓阳性的影响。采用门诊和电话方式进行随访，了解患者生存情况。随访时间截至2016年6月。单因素分析采用x2检验。多因素分析采用趋势x2检验以及二分类Logistic回归模型。结果：（1）病理学特征：1 260例胃癌患者均经术后病理学确诊，脉管癌栓阳性患者355例，阴性905例。组织分化程度：高分化13例，中分化232例，低分化775例，黏液腺癌95例，印戒细胞癌145例。浸润深度：黏膜层或黏膜下层（T1期）242例，肌层 （T2期）160例，胃壁全层未达浆膜层（T3期）37例，浆膜外（T4期）821例。淋巴结转移：无区域淋巴结转移（N0期）461例，1～2枚淋巴结转移（N1期）164例，3～6枚淋巴结转移（N2期）245例，≥7枚淋巴结转移（N3期）390例。肿瘤TNM分期：ⅠA期191例，ⅠB期114例，ⅡA期62例，ⅡB期202例，ⅢA期132例，ⅢB期80例 ，ⅢC期476例，Ⅳ期3例。（2）随访情况：1 142例患者获得术后随访（脉管癌栓阳性患者 320例、阴性822例），随访率90.635%（1 142/1 260），随访时间为4.0～24.0个月，中位随访时间为11.0个月。随访期间154例患者死亡，其中脉管癌栓阳性41例、阴性113例。（3）脉管癌栓阳性的�Objective：To analyze the clinicopathologic factors affecting the formation of lymphovascular invasion （LVI） in patients with gastric cancer. Methods：The retrospective casecontrol study was conduted. The clinicopathologic data of 1 260 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between January 2014 and December 2015 were collected. All the surgical specimens of patients were detected by hematoxylineosin （HE） stain and diagnosed by pathological experts. Stages of patients were evaluated by the seventh TNM staging system for gastric cancer of American Joint Committee on Cancer （AJCC） and Union for International Cancer Control （UICC）. Observation indicators： （1） pathologica features： histological differentiation, invasive depth, lymph node metastasis and TNM staging; （2） followup situations; （3） influenced factors of the positive LVI： sex, age, histological differentiation, invasive depth, number of lymph node metastasis and TNM staging affecting positive LVI were analyzed. Followup using outpatient examination and telephone interview were performed to detect survival of patients up to June 2016. Univariate analysis was done using the chisquare test, and multivariate analysis was done using the trend chisquare test, and binary Logistic regression model.Results：（1） Pathological features： 1 260 patients with gastric cancer were diagnosed by postoperative pathological examinations, including 355 with positive LVI and 905 with negative LVI. Histological differentiation： highdifferentiated tumor was detected in 13 patients, moderatedifferentiated tumor in 232 patients and lowdifferentiated tumor in 775 patients. There were 95 patients with mucinous adenocarcinoma and 145 with signetring cell carcinoma. Invasive depth： tumor invasion into mucosal layer or submucosal layer （T1 stage） was detected in 242 patients, muscular layer （T2 stage） in 160 patients, gastric wall layer and no invasion into serosa

关 键 词：胃肿瘤 脉管癌栓 淋巴结转移数目 

分 类 号：R735.2[医药卫生—肿瘤]