胃癌伴左锁骨上淋巴结转移患者的临床病理特征及预后  

Analysis of clinicopathological characteristics and prognosis of gastric cancer patients with left supraclavicular lymph node metastasis

作　　者：丁平安 杨沛刚[1] 田园[1] 胡奕炀 郭洪海[1] 刘洋[1] 张志栋[1] 王冬[1] 李勇[1] 赵群[1] DING Ping′an;YANG Peigang;TIAN Yuan;HU Yiyang;GUO Honghai;LIU Yang;ZHANG Zhidong;WANG Dong;LI Yong;ZHAO Qun(The Third Department of Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院外三科,石家庄050011

出　　处：《实用医学杂志》2021年第13期1695-1700,共6页The Journal of Practical Medicine

基　　金：河北卫健委县级公立医院适宜卫生技术推广入库项目(编号:2019024);政府资助临床医学优秀人才培养项目(编号:2019012);河北省高等学校科学技术研究项目(编号:ZD2019139)。

摘　　要：目的探讨胃癌伴左锁骨上淋巴结转移患者的临床病理特征和预后生存分析。方法检索河北医科大学第四医院外三科自2010-2019年录入的胃癌数据库,筛选出经超声引导穿刺病理证实为左锁骨上淋巴结转移患者,分析其临床病理特征、生存预后及影响预后的相关因素。结果共检索出286例胃癌伴左锁骨上淋巴结转移患者,占同期收治胃癌患者总数2.62%。其中男157例(54.90%),女129例(45.10%);中位年龄59岁,病灶位于贲门79例(27.62%),胃体69例(24.13%),胃窦91例(31.82%),全胃47例(16.43%);病灶≥5 cm者192例(67.13%),<5 cm者94例(32.87%);Borrmann分型为Ⅰ~Ⅱ型103例(36.01%),Ⅲ~Ⅳ型183例(63.99%);高-中分化腺癌65例(22.73%),低-未分化腺癌221例(77.27%)。286例胃癌伴锁骨上淋巴结转移患者中,277例(96.85%)获得随访,2年总生存率(overall survival,OS)为51.26%、2年无进展生存率(progression-free survival,PFS)为42.24%。Cox多因素分析结果显示,肿瘤组织类型为低分化-未分化类型(P=0.028)、浸润深度为cT4a~cT4b期(P=0.005)、肿瘤标志物CEA表达阳性(P=0.007)、同时合并腹腔脱落细胞学阳性及腹膜转移(P=0.001)是影响胃癌伴左锁骨上淋巴结转移患者预后的独立危险因素,而接受转化治疗(包括全身性化疗或全身性化疗+HIPEC化疗)(P=0.001)及行R0手术治疗是影响患者预后的保护性因素(P=0.001)。结论胃癌伴左锁骨上淋巴结转移患者预后较差,与多种临床因素密切相关,而进行积极的转化治疗将会改善患者预后。Objective To investigate the clinicopathological characteristics and survival analysis of patients with gastric cancer with left supraclavicular lymph node metastasis.Methods from 2010 to 2019 in the Department of Surgery of the Third Hospital of Hebei Medical University from 2010 to 2019 was retrieved,and the ultrasound-guided puncture pathology to confirm the left supraclavicular lymph node metastasis was screened out.The clinical pathological characteristics,survival and related prognostic factors were analyzed.Results retrieved,accounting for 2.62%of the total number of gastric cancer patients admitted during the same period.Among them,there were 157 males(54.90%)and 129 females(45.10%),and the median age was 59 years old.79 cases(27.62%)were located in the cardia,69 cases(24.13%)in the gastric body,and 91 cases(31.82%)in the antrum,47 cases(16.43%)of whole stomach;192 cases(67.13%)with lesions≥5 cm,94 cases(32.87%)with lesions less than 5 cm;103 cases(36.01%)with Borrmann classification of typeⅠtoⅡ,and typeⅢtoⅣ183 cases(63.99%);65 cases(22.73%)of high-medium differentiated adenocarcinoma,and 221 cases(77.27%)of low-undifferentiated adenocarcinoma.Of the 286 patients with gastric cancer with supraclavicular lymph node metastasis,277(96.85%)were followed up,with a 2-year overall survival(OS)of 51.26%and a 2-year progression-free survival(PFS)of 42.24%.COX multivariate analysis showed that the tumor tissue type was poorly differentiated-undifferentiated type(HR=2.164,95%CI:1.085~8.316,P=0.028),and the depth of invasion was cT4 a~cT4 b stage(P=0.005),tumor marker CEA(P=0.007),combined with positive abdominal exfoliation cytology and peritoneal metastasis(P=0.001)is an independent risk factor affecting the prognosis of gastric cancer patients with left supraclavicular lymph node metastasis,and they received conversion therapy(including systemic chemotherapy or systemic chemotherapy+HIPEC chemotherapy)(P=0.001)and R0 surgery treatment is a protective factor affecting the prognosis(P=0.001).Conclusion sup

关 键 词：胃肿瘤 左锁骨上淋巴结转移 临床特征 预后 

分 类 号：R735.2[医药卫生—肿瘤]