早期胃癌淋巴结转移独立危险因素分析  

Analysis of independent risk factors of lymph node metastasis in early gastric cancer

作　　者：池良杰 许超[1] 王襄瑜[1] 陈黎奇[1] 吴健生[1] 陈鸿源[1] 郑羽[1] CHI Liangjie ;XU Chao;WANG Xiangyu;CHEN Liqi;WU Jiansheng ;CHEN Hongyuan;ZHENG Yu(College of Clinical Medicine,Fujian Medical University;Department of Gastrointestinal Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院胃肠外科,福建福州350001

出　　处：《中国现代医生》2018年第17期31-34,共4页China Modern Doctor

基　　金：福建省自然科学基金项目(2016J01504)

摘　　要：目的探讨早期胃癌淋巴结转移的独立危险因素,为不同临床特征的早期胃癌患者制定最佳的治疗方案提供依据。方法回顾性分析2012年6月～2016年12月期间在本院行手术治疗及病理确诊为早期胃癌的病例235例,收集患者的性别、年龄、肿瘤位置分区、肉眼分型、肿瘤大小、肿瘤侵犯深度、肿瘤分化程度、脉管侵犯、淋巴管侵犯以及神经侵犯等临床病理特征,采用χ~2检验或Fisher精确概率法进行单因素分析,用二元Logistic回归分析进行多因素分析。结果 235例早期胃癌淋巴结转移率为11.9%;单因素分析显示:肿瘤大小、侵犯深度、分化程度、脉管侵犯、淋巴管侵犯与早期胃癌淋巴结转移存在相关性(P<0.05)。多因素分析显示:肿瘤大小(P=0.002)和肿瘤分化程度(P=0.003)为早期胃癌淋巴结转移的独立危险因素。对于胃下部癌,第6组淋巴结转移率最高(8.6%);对于胃中部癌,第3组淋巴结转移率最高(3.6%);对于胃上部癌,第1组淋巴结转移率最高(4.8%)。结论对于肿瘤大小超过20 mm以及分化程度低的早期胃癌患者,不建议行内镜治疗。Objective To explore the independent risk factors for lymph node metastasis in early gastric cancer,in order to provide the basis for developing the best treatment for early gastric cancer patients with different clinical characteristics.Methods 235 cases of early gastric cancer were surgically treated and pathologically diagnosed at Fujian Provincial hospital from June 2012 and December 2016 were retrospectively analyzed.Gender,age,tumor location,macroscopic classification,and the size,invasion depth,differentiation,vascular invasion,lymphatic invasion and nerve invasion of tumor were collected.Usedχ2 test or Fisher's exact probability method to perform univariate analysis and using binary logistic regression analysis for multivariate analysis.Results The metastatic rate of lymph node in 235 patients with early gastric cancer was 11.9%.Univariate analysis showed that tumor size,invasion depth,tumor differentiation,vascular invasion,and lymphatic invasion were correlated to lymph node metastasis in early gastric cancer(P<0.05).Multivariate analysis showed that tumor size(P=0.002)and tumor differentiation(P=0.003)were independent risk factors for lymph node metastasis in early gastric cancer.For the lower gastric carcinoma,the lymph node metastasis rate was highest in the 6th group(8.6%);for the middle gastric cancer,the lymph node metastasis rate was highest in the 3th group(3.6%);for the upper gastric cancer,the lymph node metastasis rate was highest in first group(4.8%).Conclusion Endoscopic treatment is not recommended for patients with early gastric cancer whose tumor size exceeds 20 mm and whose differentiation is low.

关 键 词：早期胃癌 淋巴结转移 独立危险因素 手术治疗 回顾性研究 

分 类 号：R735.2[医药卫生—肿瘤]