早期胃癌患者淋巴结转移危险因素分析及风险预测模型的建立  

Stratifying risk and establishing predictive risk-scoring model for lymph-node metastasis in early gastric cancer

作　　者：韩文秀[1] 徐阿曼[1] 陈章明[1] 韦之见[1] 刘虎[1] Han Wenxiu Xu Aman Chen Zhangming Wei Zhijian Liu Hu.(Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Chin)

机构地区：[1]安徽医科大学第一附属医院胃肠外科,合肥230022

出　　处：《中华普通外科杂志》2017年第4期285-288,共4页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（81572350）

摘　　要：目的探讨早期胃癌患者发生淋巴结转移的独立危险因素，并初步建立简便有效的淋巴结转移风险预测模型。方法回顾性分析2011年7月至2016年4月安徽医科大学第一附属医院普外科收治的962例行胃癌根治术早期胃癌患者的临床资料，采用Х^2检验或Fisher确切概率法对不同临床病理特征与淋巴结转移情况进行单因素分析，应用Logistic回归多因素分析筛查影响早期胃癌发生淋巴结转移的独立危险因素，进一步根据各因素相对危险度给予赋值，计算风险评分并采用AOC曲线检验诊断效能。结果肿瘤≤2cm、分化型黏膜内癌，无论是否存在溃疡的早期胃癌患者均存在淋巴结转移，但淋巴结转移率较低（〈3．0％）。单因素和多因素分析结果表明浸润至黏膜下层、肿瘤〉2cm、未分化型、存在脉管侵袭的女性早期胃癌患者是发生淋巴结转移的独立危险因素，其相对危险度分别为3．173、1．956、1．922、9．027和1．893（均P〈0．05）。AOC曲线下面积达到0．768（P〈0．01）。结论肿瘤〉2cm、未分化型、存在脉管侵袭并且浸润至黏膜下层的女性早期胃癌患者发生淋巴结转移风险较高。Objective To explore the independent risk factors of lymph-node metastasis （LNM） in patients with early gastric cancer （EGC）, and establish a risk-prediction model based on LNM. Method 962 early gastric cancer patients undergoing curative radical gastrectomy in the First Hospital of Anhui Medical University from July 2011 to April 2016 were enrolled in this study. The relationships between different clinicopathologic characteristics and LNM were analyzed by Chi-square test or Fisher exact probability, and the independent risk factors were determined using Logistic regression analysis. Moreover, LNM risk was stratified and a risk-predicting model was established on the basis of the identified independent risk factors for LNM. Further, the risk-predicting model was validated using 962 EGC cases. The discriminatory accuracy of risk-predicting model was measured by area under ROC curve （ROC-AUC）. Results Mucosal differentiated cancer ≤2 cm, irrespective of the existence of an ulcer, had low LNM rates （ LNMR 〈 3.0% ）. Univariate and multivariate analysis revealed that female EGC patients with submucosal, undifferentiated, vessel invasion and tumor size 〉 2 cm were independent risk factors of LNM for EGC patients, and relative risks were 1. 893, 3. 173, 1. 956, 1. 922 and 9. 027 respectively （P 〈 0. 05）. ROC- AUC of risk-predicting model was 0. 768 （P 〈 0. 01 ）, which showed high diagnostic accuracy and sensitivity. Conclusion Female EGC patients with submucosal undifferentiated carcinomas measuring 〉 2 cm with vessel invasion have higher risk of LNM.

关 键 词：胃肿瘤 淋巴转移 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]