进展期胃癌淋巴结转移的相关危险因素分析

发布时间：2018-03-28 06:50

  本文选题：进展期胃癌　切入点：淋巴结转移　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:探讨进展期胃癌淋巴结转移相关危险因素,为进展期胃癌患者综合治疗方案提供理论依据。方法:回顾性分析河北医科大学第四医院2010年1月至2015年12月期间收治的行胃癌根治手术治疗并具有完整病例资料的进展期胃癌(T_(2-4)N_(0-3)M_0)患者共计337例。应用SPSS19.0统计软件χ~2检验分析性别、年龄、肿瘤部位、肿瘤大小、Borrmann分型、分化程度、浸润深度、脉管瘤栓、肿瘤标记物、免疫组化指标等对进展期胃癌淋巴结转移的影响。为排除各种因素之间的相互作用,采用多因素非条件Logistic回归分析对相关因素进行分析,P0.05认为差异有统计学意义。结果:1进展期胃癌淋巴结转移的危险因素单因素分析:1.1女性患者淋巴结转移率明显高于男性患者(χ~2=8.217,P=0.004)。1.2 CA-19927 U/m L患者淋巴结转移率明显高于CA-199≤27 U/m L者(χ~2=9.984,P=0.002);CA72-46.9 U/m L患者者淋巴结转移率明显高于CA72-4≤6.9 U/m L者(χ~2=8.676,P=0.003)。1.3肿瘤直径≥4cm淋巴结转移率明显高于肿瘤直径4cm的患者(χ~2=18.269,P=0.000);随着T分期的增加,患者淋巴结转移率明显升高(χ~2=23.940,P=0.000);有脉管瘤栓患者的淋巴结转移率明显高于无脉管瘤栓者(χ~2=16.283,P=0.000);浸润型(BorrmannⅢ型、Ⅳ型)胃癌患者淋巴结转移率明显高于局限型(BorrmannⅠ型、Ⅱ型)患者(χ~2=4.063,P=0.044),但BorrmanⅠ、Ⅱ型之间和BorrmanⅢ、Ⅳ型之间的差异无显著统计学意义(P0.05)。1.4血小板(P=0.624)、白蛋白(P=0.190)、NLR(P=0.793)、PLR(P=0.458)、FIB(P=0.466)与进展期胃癌淋巴结转移差异均无统计学意义。1.5胃癌组织中EGFR(χ~2=5.076,P=0.024)、HER2(χ~2=5.089,P=0.024)、P53(χ~2=5.192,P=0.023)、TOPOⅡ(χ~2=4.546,P=0.033)的阳性表达及Ki67高表达(χ~2=4.661,P=0.031)与进展期胃癌淋巴结转移有关。2进展期胃癌淋巴结转移的危险因素多因素分析:CA-199水平(OR:0.267,(0.088-0.812);P=0.020)、CA72-4水平(OR:0.328,(0.124-0.865);P=0.024)、浸润深度(OR:1.891,(1.249-2.862);P=0.003)与进展期胃癌淋巴结转移独立相关,而肿瘤大小、脉管瘤栓、Borrman分型等并非反应进展期胃癌淋巴结转移的独立影响因素。结论:1进展期胃癌淋巴结转移与CA-199水平、CA72-4水平、肿瘤大小、浸润深度、脉管瘤栓及Bormann分型密切相关;CA-199、CA72-4水平越高、肿瘤的直径≥4cm、T分期越晚、有脉管瘤栓、大体分型为浸润型(BorrmannⅢ型、Ⅳ型),则淋巴结转移率越高。多因素分析中,CA-199、CA72-4水平及浸润深度为影响进展期胃癌淋巴结转移的独立危险因素。因此我们认为术前将以上危险因素进行有效整合,可筛选出淋巴结转移的高危人群,为胃癌患者的根治性决策提供参考。2胃癌组织中EGFR、HER2、P53、TOPOⅡ的阳性表达及Ki67高表达与肿瘤的侵袭转移有关,可作为进展期胃癌淋巴结转移高危因素的预测指标。探究这一规律性,对预测进展期胃癌淋巴结转移的危险性、制定合理的综合治疗方案具有重要的意义。
[Abstract]:Objective: to investigate the risk factors of lymph node metastasis in advanced gastric cancer. Methods: to provide theoretical basis for comprehensive treatment of advanced gastric cancer patients. Methods: retrospective analysis of radical operation of gastric cancer from January 2010 to December 2015 in the fourth Hospital of Hebei Medical University. A total of 337 patients with advanced gastric cancer were collected. The SPSS19.0 statistical software 蠂 ~ 2 was used to test and analyze the sex. Age, tumor location, tumor size and Borrmann classification, degree of differentiation, depth of invasion, vascular embolus, tumor markers, immunohistochemical markers and other factors affect lymph node metastasis of advanced gastric cancer. Multivariate non-conditional Logistic regression analysis was used to analyze the related factors. (P0.05) the difference was statistically significant. Results the univariate analysis of the risk factors of lymph node metastasis of advanced gastric cancer in 1: 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. The lymph node metastasis rate in the patients with CA-19927 U / mL was significantly higher than that in the patients with CA-199 鈮，

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