D_2^+淋巴结清扫术在进展期胃癌治疗中的临床价值  

The clinical value of D_2^+ lymph node dissection for advanced gastric cancer

作　　者：崔海滨[1] 白希永[1] 葛怀娥[1] 张维[1] 王永森[1] 边青召[1] CUI Haibin;BAI Xiyong;GE Huaie;ZHANG Wei;WANG Yongsen;BIAN Qingzhao(First Department of Surgical Oncology,Central Hospital of Cangzhou,Cangzhou 061001,Hebei,China)

机构地区：[1]沧州市中心医院肿瘤外一科,河北沧州061001

出　　处：《癌症进展》2018年第10期1264-1267,共4页Oncology Progress

基　　金：沧州市2014年科学技术研究与发展指导计划项目(141302076)

摘　　要：目的探讨D_2^+淋巴结清扫术在进展期胃癌治疗中的临床价值。方法回顾性分析352例进展期胃癌患者的病历资料,其中102例(29.0%)患者行D_2^+淋巴结清扫术,作为D_2^+淋巴结清扫术组;250例(71.0%)患者行D2淋巴结清扫术,作为D2淋巴结清扫术组。分析D_2^+和D2两种不同淋巴结清扫方式对患者预后的影响,探讨D_2^+淋巴结清扫术在进展期胃癌治疗中的价值。结果 352例患者的中位生存时间为30.5个月,5年生存率为43.2%。D_2^+淋巴结清扫术组和D2淋巴结清扫术组患者的5年生存率分别为52.9%和39.2%,差异有统计学意义(P=0.018)。单因素生存分析结果显示,年龄、淋巴结清扫方式、肿瘤最大径、T分期、N分期与进展期胃癌患者的预后有关(P﹤0.05);多因素Cox分析结果显示,淋巴结清扫方式、T分期与N分期均是进展期胃癌患者预后的影响因素(P﹤0.05)。结论对于进展期胃癌,选择性D_2^+淋巴结清扫术可以使患者临床获益,但仍需多中心大样本前瞻性研究进一步证实。Objective To evaluate the clinical value of D2^＋lymph node dissection in the treatment of advanced gastric cancer. Method Case data of 352 cases who were diagnosed as advanced gastric cancer receiving D2^＋（n=102, 29.0%） or D2（n=250, 71.0%） lymph node dissection were analyzed retrospectively. The effect of D2^＋and D2 lymph node dissection on prognosis of these patients were investigated to evaluate the clinical value of D2^＋lymph node dissection. Result The median survival time was 30.5 months and the 5-year overall survival rate was 43.2% in the 352 patients, while the 5-year overall survival rates in D2^＋lymph node dissection group and D2 lymph node dissection group were 52.9% and 39.2% respectively, and the difference was statistically significant（P=0.018）. Univariate analysis showed that age, different regimens of lymph node dissection, maximum diameter of tumor, T stage, N stage were associated with the prognosis of advanced gastric cancer（P〈0.05）; multivariate analysis indicated that different regimens of lymph node dissection, T stage and N stage were as influence factors for advanced gastric cancer（P〈0.05）. Conclusion For advanced gastric cancer,the regimen of selective D2^＋lymph node dissection is beneficial, though multicenter, large-sample and prospective studies are warranted.

关 键 词：胃肿瘤 进展期 D2^+淋巴结清扫术 生存率 

分 类 号：R735.2[医药卫生—肿瘤]