早期胃癌淋巴结转移预测因素的临床分析

发布时间：2018-08-09 19:46

【摘要】：目的:手术是治疗早期胃癌的主要治疗手段。淋巴结状态是影响早期胃癌的预后的关键因素,胃癌根治术中清扫淋巴结虽可降低术后复发与远处转移,但过度清扫淋巴结可能导致患者术后生活质量降低和相应的并发症。探讨早期胃癌的临床病理学特征及其与淋巴结转移的关系,预测和总结早期胃癌的淋巴结转移规律,为个体化治疗、缩小手术范围提供依据。方法:回顾性分析2006年11月-2015年7月间在芜湖市第二人民医院胃肠外科收治的接受根治性手术的147例早期胃癌患者的临床病理资料。分析患者年龄、性别、肿瘤大小、肿瘤部位、大体分型、分化程度、浸润深度、有无神经侵犯、有无淋巴管癌栓等情况。采用卡方检验分析早期胃癌淋巴结转移与各临床病理特征间的关系,采用Logistic回归模型进行早期胃癌淋巴结转移独立危险因素分析。结果:147例早期胃癌患者淋巴结转移率为17.0%(25/147),其中黏膜内癌为7.7%(5/65),黏膜下癌为24.4%(20/82)。总共切除2171枚淋巴结,110枚发生转移,转移率为5.1%。18例患者仅第1站淋巴结转移,4例出现跳跃性转移,3例同时出现第1站和第2站转移,1例患者出现第3站淋巴结转移。第1站淋巴结转移18例,以第7组和第3组转移频次最高,各9例;第2站淋巴结转移7例,局限于第8a组(4例)和第9组(3例)。印戒细胞癌与分化型腺癌、低分化腺癌相比,在肿瘤大小(P=0.041,P=0.007)和浸润深度(P=0.001)方面差异均有统计学意义,其淋巴结转移率明显低于低分化型腺癌,差异有统计学意义(P=0.021),但与分化型腺癌(13.1%,42/321)比较差异无统计学意义(P=0.406)。单因素分析显示女性(P=0.013)、浸润深度(P=0.007)、和淋巴管肿瘤浸润(P=0.000)与淋巴结转移显著相关;多因素分析结果显示浸润深度(P=0.016)和淋巴管肿瘤浸润(P=0.006)为淋巴结转移的独立危险因素。结论:临床医师术前可通过超声内镜、CT和病理学检查确定早期胃癌的有无淋巴结肿大以及肿瘤大小、浸润深度和组织学类型,推测有无淋巴结转移倾向,肿瘤局限于黏膜内癌、无脉管瘤栓的早期胃癌发生淋巴结转移风险小,从而选择合理的手术方式和术中淋巴结清扫范围。
[Abstract]:Objective: surgery is the main treatment for early gastric cancer. Lymph node status is a key factor affecting the prognosis of early gastric cancer. Although lymph node dissection in radical gastrectomy can reduce recurrence and distant metastasis, excessive lymph node dissection may lead to the decrease of postoperative quality of life and corresponding complications. To explore the clinicopathological characteristics of early gastric cancer and its relationship with lymph node metastasis, predict and summarize the law of lymph node metastasis of early gastric cancer, and provide basis for individualized treatment and reduction of surgical scope. Methods: the clinical and pathological data of 147 patients with early gastric cancer treated in gastrointestinal surgery of Wuhu second people's Hospital from November 2006 to July 2015 were retrospectively analyzed. Age, sex, tumor size, tumor location, gross classification, differentiation, depth of invasion, nerve invasion and lymphatic thrombus were analyzed. The relationship between lymph node metastasis and clinicopathological features of early gastric cancer was analyzed by chi-square test. The independent risk factors of lymph node metastasis of early gastric cancer were analyzed by Logistic regression model. Results the lymph node metastasis rate of 147 cases of early gastric cancer was 17.0% (25 / 147), of which intramucosal carcinoma was 7.7% (5 / 65), submucosal carcinoma was 24.4% (20 / 82). A total of 2171 lymph nodes were removed, and the metastasis rate was 5.1. 18 cases. Only 4 cases had leaping metastasis in the first station, 3 cases had the first and second station metastasis and 1 case had the third station lymph node metastasis. The frequency of lymph node metastasis in group 7 and group 3 was the highest in group 7 and group 3 respectively, and in group 2, lymph node metastasis was limited to group 8a (4 cases) and group 9 (3 cases). There were significant differences in tumor size (P0. 041) and depth of invasion (P0. 001) between signet-ring cell carcinoma and differentiated adenocarcinoma and poorly differentiated adenocarcinoma. The lymph node metastasis rate of signet ring cell carcinoma was significantly lower than that of poorly differentiated adenocarcinoma. The difference was statistically significant (P0. 021), but there was no significant difference between P0. 021 and differentiated adenocarcinoma (13. 1 / 321) (P0. 406). Univariate analysis showed that women (P0. 013), depth of invasion (P0. 007) and lymphatic tumor invasion (P0. 000) were significantly associated with lymph node metastasis, and multivariate analysis showed that the depth of invasion (P0. 016) and lymphatic tumor invasion (P0. 006) were independent risk factors for lymph node metastasis. Conclusion: before operation, the clinicians can determine the lymph node enlargement, tumor size, depth of invasion and histological type of early gastric cancer by endoscopic CT and pathological examination, and speculate whether there is a tendency of lymph node metastasis, and whether the tumor is confined to intramucosal carcinoma. The risk of lymph node metastasis in early gastric cancer without vascular embolus is low, so the reasonable surgical procedure and the scope of lymph node dissection during operation are selected.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.2

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