早期胃癌淋巴结转移危险因素预测。
Prediction of risk factors for lymph node metastasis in early gastric cancer.
机构信息
Department of Radiology, Xinhua Hospital, Shanghai Jiaotong University Medical School, Shanghai 200092, China.
出版信息
World J Gastroenterol. 2013 May 28;19(20):3096-107. doi: 10.3748/wjg.v19.i20.3096.
AIM
To explore risk factors for lymph node metastases in early gastric cancer (EGC) and to confirm the appropriate range of lymph node dissection.
METHODS
A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery, Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009, were retrospectively reviewed. Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines. The macroscopic type was classified as elevated (type I or IIa), flat (IIb), or depressed (IIc or III). Histopathologically, papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas, and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas. Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.
RESULTS
The lymph node metastases rate in patients with EGC was 14.4%. Among these, the rate for mucosal cancer was 5.4%, and 8.9% for submucosal cancer. Univariate analysis showed an obvious correlation between lymph node metastases and tumor location, depth of invasion, morphological classification and venous invasion (χ(2) = 122.901, P = 0.001; χ(2) = 7.14, P = 0.008; χ(2) = 79.523, P = 0.001; χ(2) = 8.687, P = 0.003, respectively). In patients with submucosal cancers, the lymph node metastases rate in patients with venous invasion (60%, 3/5) was higher than in those without invasion (20%, 15/75) (χ(2) = 4.301, P = 0.038). Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018, Exp (B) = 2.744]. Among the patients with lymph node metastases, 29 cases (14.4%) were at N1, seven cases were at N2 (3.5%), and two cases were at N3 (1.0%). Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN1 (P = 0.008).
CONCLUSION
The depth of invasion was the only independent risk factor for lymph node metastases. Risk factors for metastases should be considered when choosing surgery for EGC.
目的
探讨早期胃癌（EGC）淋巴结转移的危险因素，明确合理的淋巴结清扫范围。
方法
回顾性分析 2003 年 11 月至 2009 年 7 月上海交通大学医学院附属新华医院和瑞金医院外科行根治性胃切除术并进行淋巴结清扫的 202 例 EGC 患者的临床资料。手术方式和淋巴结清扫范围均根据日本胃癌治疗指南推荐。大体类型分为隆起型（Ⅰ型或Ⅱa 型）、平坦型（Ⅱb 型）或凹陷型（Ⅱc 型或Ⅲ型）。组织病理学上，将乳头状和管状腺癌归为分化腺癌，将低分化和印戒细胞腺癌视为未分化腺癌。对淋巴结转移和患者及肿瘤特征进行单因素和多因素分析。
结果
EGC 患者的淋巴结转移率为 14.4%。其中黏膜癌转移率为 5.4%，黏膜下癌转移率为 8.9%。单因素分析显示，淋巴结转移与肿瘤部位、浸润深度、形态分类和静脉侵犯明显相关（χ²=122.901，P=0.001；χ²=7.14，P=0.008；χ²=79.523，P=0.001；χ²=8.687，P=0.003）。在黏膜下癌患者中，有静脉侵犯者（60%，3/5）的淋巴结转移率高于无侵犯者（20%，15/75）（χ²=4.301，P=0.038）。多因素 logistic 回归分析显示，浸润深度是 EGC 淋巴结转移的唯一独立危险因素（P=0.018，Exp（B）=2.744）。在淋巴结转移患者中，29 例（14.4%）为 N1，7 例为 N2（3.5%），2 例为 N3（1.0%）。单因素方差分析显示，浸润深度与 pN1 淋巴结转移密切相关（P=0.008）。
结论
浸润深度是淋巴结转移的唯一独立危险因素。在选择 EGC 的手术治疗时，应考虑转移的危险因素。
Zotero 插件