多灶性胃癌病人淋巴结转移危险因素及预后分析  

Clinical analysis of risk factors and prognosis of patients with multifocalgastric cancer and lymph nodemetastasis

作　　者：徐冉[1] 杨年钊 赵海远 李阳[1] 赵军[1] 张义胜[1] XU Ran;YANG Nianzhao;ZHAO Haiyuan(Department of General Surgery,the Yijishan Hospital of Wannan Medical College,Anhui Province,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院,安徽芜湖241001

出　　处：《临床外科杂志》2020年第8期774-777,共4页Journal of Clinical Surgery

摘　　要：目的探讨多灶性胃癌病人淋巴结转移危险因素以及对病人预后的影响。方法2013年1月~2017年1月间收治胃癌病人2012例,术后病理组织学检查确诊为多灶性胃癌病人36例,收集36例病人的临床资料,包括年龄,性别,手术方式,病灶数目、部位、分化、T分期、最大直径,脉管、神经侵犯情况,淋巴结清扫数目及淋巴结转移数目。依据淋巴结是否转移分为两组,淋巴结阳性组19例,淋巴结阴性组17例。分析淋巴结转移的危险因素,统计两组3年生存率。生存分析采用kaplan-Meier法和Log rank检验,多因素分析采用Cox回归模型。结果单因素分析显示,多灶性胃癌淋巴结转移与主灶侵犯深度、神经侵犯及主辅灶分布不同区域有关(P<0.05),多因素分析显示,主灶侵犯深度是淋巴结转移的独立危险因素(P<0.05)。随访结果表明,淋巴结阳性组3年生存率为52.6%,淋巴结阴性组3年生存率为88.2%,阳性组生存率低于阴性组,差异有统计学意义(P<0.05)。结论多灶性胃癌是一种特殊类型胃癌,主灶的侵犯深度是淋巴结转移的独立危险因素,淋巴结转移可能表明预后不佳。Objective To study the risk factors of lymph node metastasis in patients with multifocalgastric cancer and to analyze its influence on the prognosis.Methods From January 2013 to January 2017,2012 patients were diagnosed by pathology and underwent surgery,36 patients with multifocal gastric cancer were enrolled into this study.The retrospective analysis was performed.The clinic-pathological data were retrospectively analyzed,mainly including age,gender,surgical mode,carcinoma-related date(quantity,location,degree of differentiation,T stage,tumor diameter,vascular tumor thrombus,nerve tumor thrombus)and lymph node status(number of lymph nodes dissected,lymph node metastasis).36 patients were divided into non-metastatic group(17 cases)and metastatic group(19 cases).Logistic regression were performed to analyze the risk factors of lymph node metastasis.The 3-year overall survival rate of the two groups was calculated.The survival analysis was performed using the Kaplan-Meier and log-rank test and multi-factor analysis with the Cox proportional hazard regression model.Results Univariate analysis showed that the depth of invasion,nerve invasion and lesions distributed in different areas were the risk factors of lymph node metastasis(P<0.05).Multivariate regression analysis showed that depth of main tumor invasionis independent risk factors for lymph node metastasis(P<0.05).The 3-year survival rate of lymph node metastasis group was 52.6%.The 3-year survival rate of lymph node non-metastatic group was 88.2%.The results of follow-up showed that the 3-year survival rate of the patients with lymph node metastasis was significantly lower than that of the patients without metastasis,with significant difference(P<0.05).Conclusion Multifocal gastric cancer is a special type of gastric cancer,depth of main tumor invasionis independent risk factors for lymph node metastasis.Patients with lymph node metastasis have a poor prognosis.

关 键 词：胃肿瘤 多灶癌 淋巴结转移 危险因素 预后 

分 类 号：R735.2[医药卫生—肿瘤]