淋巴结转移率和病理学淋巴结分期对胃癌根治术后患者的预后评估  

Comparative study on metastatic lymph node radio and pathological lymph node stage in prognosis evaluation of patients with gastric cancer after radical resection

作　　者：辛磊[1] 宋波[1] 王莉[1] 于强宗 宫红彦 张月娟 Xin Lei;Song Bo;Wang Li;Yu Qiangzong;Gong Hongyan;Zhang Yuejuan(Department of Gastrointestinal Surgery,Yantai Yantaishan Hospital,Yantai 264000,China;Department of Pathology,the Affiliated Hospital of Qingdao University,Qingdao 266500,China)

机构地区：[1]山东省烟台市烟台山医院胃肠外科,烟台264000 [2]青岛大学附属医院病理科,266500

出　　处：《中华内分泌外科杂志》2021年第3期293-298,共6页Chinese Journal of Endocrine Surgery

摘　　要：目的研究淋巴结转移率(rN)和病理学淋巴结分期(pN)对胃癌根治术后患者预后的评估价值。方法回顾性分析2013年1月至2017年12月间于烟台市烟台山医院491例行胃癌根治术患者的临床病理资料。利用X-tile软件对淋巴结转移率进行rN分组;根据淋巴结转移数目进行pN分期。评估淋巴结转移率与其他临床病理因素的相关性。对比淋巴结转移率和病理学淋巴结分期对胃癌根治术后患者预后的评估价值。结果X-tile分析显示本研究淋巴结转移率的最佳截断值为0.14(14%)和0.63(63%)。根据截断值将纳入研究的491例患者分为rN1(256例)、rN2(160例)和rN3(75例)3个亚组,组间差异分析结果显示肿瘤直径、肿瘤部位、手术切除范围、分期、lauren分型、分化程度、pT、pN、脉管癌栓、神经侵犯、病理学TNM分期组间差异显著。rN与pN分期对胃癌根治术后患者预后评估对比:①Kaplan-Meier生存分析结果显示rN表现优于pN。②在单因素和多因素的cox分析中均显示rN为胃癌预后的独立危险因素。单因素分析中rN分组HR=3.18(95%CI 2.63~3.84,P<0.001),pN分期HR=1.88(95%CI 1.66~2.15,P<0.001);多因素分析中rN分组HR=2.21(95%CI 1.73~2.82,P<0.001),pN分期HR=1.31(95%CI 0.95~1.79,P=0.095)。③依时性ROC分析显示在术后随访52个月前rN的预后能力优于pN分期,52个月后pN分期更具优势。④将Lauren分型作为分层因子进行分层分析,Kaplan-Meier生存曲线提示肠型、混合型和弥漫型胃癌中rN均优于pN分期,AUC曲线显示混合型和弥漫型胃癌患者中rN预测能力优于pN分期,而肠型胃癌患者中pN分期表现略优。结论rN是影响胃癌根治术后患者预后的独立因素。在判断胃癌根治术后52个月内患者的预后时,rN的预后价值优于pN。在Lauren分型中混合型和弥漫型的胃癌患者,rN体现更好的预后价值。Objective To study the value of metastatic lymph node radio(rN)and pathological lymph node stage(pN)in evaluating the prognosis of patients after radical gastric cancer.Methods The clinicopathological data of 491 patients who underwent radical gastrectomy in Tantai Yantaishan Hospital from Jan.2013 to Dec.2017 were retrospectively analyzed.X-tile software was used to group the metastatic lymph node radio by rN.According to the number of lymph node metastasis,pN stage was performed.The correlation between metastatic lymph node radio and other clinicopathological factors was assessed.The metastatic lymph node radio and the pathological lymph node stage in evaluating the prognosis of patients after radical gastric cancer were compared.Results(1)X-tile analysis showed that the best cut-off values for the metastatic lymph node radio in this study were 0.14(14%)and 0.63(63%).(2)According to the cut-off value,the 491 patients included in the study were divided into rN1(256 cases),rN2(160 cases),and rN3(75 cases)three subgroups.The results of the analysis of differences showed that there were significant differencesbetween the groups in terms of tumor diameter,tumor location,surgical resection range,stage,lauren classification,degree of differentiation,pT,pN,vascular cancer emboulus,nerve invasion,and pathological TNM staging groups.(3)Comparison of rN and pN staging in evaluation of the prognosis of patients after radical gastric cancer:①Kaplan-Meier survival analysis results showed that rN was better than pN.②Both single factor and multivariate cox analysis showed that rN was an independent risk factor for the prognosis of gastric cancer.In univariate analysis,rN group HR=3.18(95%CI 2.63-3.84,P<0.001),pN stage HR=1.88(95%CI 1.66-2.15,P<0.001);rN group HR=2.21 in multivariate analysis(95%CI 1.73-2.82,P<0.001),pN staging HR=1.31(95%CI 0.95-1.79,P=0.095).③The time-dependent ROC analysis showed that the prognostic ability of rN was better than pN staging before 52 months of postoperative follow-up,and pN staging was

关 键 词：胃肿瘤 根治术 淋巴结转移率 淋巴结分期 Lauren分型 

分 类 号：R573[医药卫生—消化系统]