Zhang Hong-dian, Tang Peng, Duan Xiao-feng, Yu Zhen-tao
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China. Email:
Zhonghua Wai Ke Za Zhi. 2013 Oct;51(10):882-6.
To investigate the correlation between extranodal metastasis (EM) and clinicopathologic features as well as the effect of EM on the prognosis in gastric cardia patients.
Retrospective analysis was performed for the 323 cases with histologically proven adenocarcinoma of gastric cardia who underwent curative resection from January 2000 to January 2007. There were 272 male patients and 51 female patients with their median age of 63 (22 to 85) years. The relationship between clinicopathological features and extranodal metastasis was studied. The effects of the EM on the recurrence and survival of these patients were also analyzed.
EM positive was detected in 67 (20.7%) of the 323 patients. The incidence of EM was correlated with tumor Lauren typing, differentiation degree, invasive depth and lymph node metastasis (χ(2) = 4.647-27.216, P < 0.05). The 5-year survival rate and media survival time between patients with EM and those without EM were 12.3%, 34.1% and 20, 39 months, there was a statistically significantly difference (χ(2) = 23.936, P = 0.000) in 5-year survival rate. Multivariate analysis identified that invasive depth, lymph node metustasis and EM as an independent prognostic factor of all the patients. To the last follow up, the cumulative probability of recurrence of EM-positive patients was significant higher than EM-negative patients (59.7% vs. 35.9%; χ(2) = 12.409, P = 0.000). To study furthermore, stratified analysis showed that, in the node-positive patients, the cumulative recurrence rate of EM-positive patients was higher than EM-negative patients (60.9% vs. 40.0%; χ(2) = 8.410, P = 0.004) and the 5-year survival rate of EM-positive patients was less than the EM-negative patients (12.9% vs. 30.1%; χ(2) = 12.939, P = 0.000), the differences were statistically significant.
EM positive is determined to be an independent prognosis factor of gastric cardia after curative resection. EM-positive patients have a high risk for recurrence and a short time to live.
探讨贲门癌患者的淋巴结外转移（EM）与临床病理特征之间的相关性以及EM对预后的影响。
对2000年1月至2007年1月间323例经组织学证实为贲门腺癌并接受根治性切除术的患者进行回顾性分析。其中男性272例，女性51例，中位年龄63（22至85）岁。研究临床病理特征与淋巴结外转移之间的关系。同时分析EM对这些患者复发和生存的影响。
323例患者中67例（20.7%）检测到EM阳性。EM的发生率与肿瘤Lauren分型、分化程度、浸润深度及淋巴结转移相关（χ(2)=4.647 - 27.216，P<0.05）。有EM和无EM患者的5年生存率及中位生存时间分别为12.3%、34.1%和20、39个月，5年生存率差异有统计学意义（χ(2)=23.936，P = 0.000）。多因素分析确定浸润深度、淋巴结转移和EM为所有患者的独立预后因素。至末次随访时，EM阳性患者的累积复发概率显著高于EM阴性患者（59.7%对35.9%；χ(2)=12.409，P = 0.000）。进一步研究分层分析显示，在淋巴结阳性患者中，EM阳性患者的累积复发率高于EM阴性患者（60.9%对40.0%；χ(2)=8.410，P = 0.004），且EM阳性患者的5年生存率低于EM阴性患者（12.9%对30.1%；χ(2)=12.939，P = 0.000），差异有统计学意义。
EM阳性被确定为贲门癌根治性切除术后的独立预后因素。EM阳性患者复发风险高且生存时间短。
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