胃癌根治术中清扫NO6组与NO14v淋巴结相关性研究
发布时间：2018-09-14 16:02
【摘要】：目的:淋巴转移是胃癌的主要转移途径,本实验通过分析验证影响幽门下区(6组)及其三个亚组淋巴结(6a,6i,6v)的转移的临床病理因素,探讨6组淋巴结转移情况下14v组淋巴结转移的情况,以及清扫14v组淋巴结对患者预后的影响。方法:回顾性收集2013年1月至2015年12月间大连医科大学附属第一医院胃肠外科治疗的398例行胃癌根治术(D2或者D1+)的患者的临床病理生理资料,筛选出清扫幽门下区(6组)患者,分析影响幽门下区(6组)及其三个亚组淋巴结(6a,6i,6v)的转移的临床病理因素,探讨6组淋巴结转移情况下14v组淋巴结转移的情况,以及清扫14v组淋巴结对患者预后的影响。结果:1、398例患者中,清扫6组淋巴结转移的患者有181例,约占总体的45.6%;6组淋巴结转移的患者有53例。6a淋巴结转移的患者有19例,转移率为35.8%(19/53);6i组淋巴结转移的患者有14例,转移率为26.4%(14/53);6v淋巴结转移的患者有20例,转移率为22.6%(9/53);清扫第6a亚组淋巴结总共136枚,每例患者可得淋巴结(1.86±2.54)枚,其中阳性淋巴23枚,淋巴结转移度为16.9%(23/136);清扫第6i亚组淋巴结总共86枚,每例得淋巴结(0.50±1.2)枚,转移淋巴结16枚,淋巴结转移度为18.6%(16/86);清扫第6v亚组淋巴结总共88枚,每例得淋巴结(0.93±1.07)枚,转移淋巴结22枚,淋巴结转移度为25.0%(22/88)。3个亚组淋巴结转移度之间差异无统计学意义(P=0.342)。2、6组淋巴结转移单因素分析显示6组淋巴结转移和肿瘤的大小,肿瘤的分化程度、N、M分期相关(p0.05);与与年龄、性别、肿瘤位置、肿瘤浸润深度(T分期)无关(p0.05)。3、6a组和3组(p0.001)、4sb组(p0.001)、4d(p0.001)、5组(p0.001)、8a组(p0.001)9组(p0.001)、12组(p0.001)淋巴结有相关性,和14v组淋巴结没有相关性(p=0.333);6i组和4sb组(p0.001)、4d(p0.001)、5组(p0.001)、7组(p0.001)、8a组(p0.001)、9组(p0.001)、12组(p0.001)淋巴结有相关性,和14v组淋巴结没有相关性(p=0.068);6v组和3组(p0.001)、4sb组(p0.001)、4d(p0.001)、5组(p0.001)、7组(p0.001)、8a组(p0.001)、9组(p0.001)淋巴结、12组(p0.001)淋巴结有相关性,和14v组淋巴结有相关性(p0.001);4、将单因素分析中影响第6v组淋巴结转移的肿瘤大小、分化程度度、N分期、M分期,及其第3、4sb、4d、5、6、7、8a、9、12a、14v组组淋巴结转移纳入logistic回归进行多变量分析,结果显示:仅远处转移,4d组、8a组、14v组淋巴结是6组淋巴结转移的独立危险因素。TNM III期患者第14v组淋巴结转移和未转移患者3年生存率分别为42.9%和57.6%(p=0.005),TNM III期患者清扫14v组淋巴结可以明显改善其预后。结论:1、有无远处转移及第4sb、4d组8a组淋巴结转移是影响第6v组淋巴结转移的独立危险因素,第6组淋巴结转移是预测第14v组淋巴结转移情况的可靠指标。2、I/11期患者第14v组淋巴结转移率低,IV期患者预后差,第14v组淋巴结清扫并不能提高此类患者生存。3、Ill期胃中下部癌患者,如发现行6v淋巴结转移,第14v组淋巴结转移率相对较高,预防性清扫第14v组淋巴结可以改善预后。
[Abstract]:Objective: lymphatic metastasis is the main metastasis pathway of gastric cancer. The clinical and pathological factors influencing lymph node metastasis in subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed in this study. To investigate the status of lymph node metastasis in 14v group under 6 groups of lymph node metastasis and the influence of dissection of 14 v group on the prognosis of the patients. Methods: the clinical pathophysiological data of 398 patients undergoing radical gastrectomy (D2 or D1) in the first affiliated Hospital of Dalian Medical University from January 2013 to December 2015 were retrospectively collected. The patients with subpyloric area (group 6) were screened out, and the clinicopathological factors affecting the metastasis of subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed, and the status of lymph node metastasis in group 14v with subpyloric lymph node metastasis was discussed. And the effect of lymph node dissection on the prognosis of patients. Results among 1398 patients, 181 cases were dissected from 6 groups of lymph node metastases, and 53 cases (.6a) were involved in 53 cases of lymph node metastasis. The metastasis rate was 35.8% (19 / 53). There were 14 cases of lymph node metastasis. The metastatic rate was 26.4% (14 / 53) and the metastatic rate was 22.6% (9 / 53) in 20 patients with 6v lymph node metastasis, 136 lymph nodes were dissected in subgroup 6a, and (1.86 卤2.54) lymph nodes were obtained in each patient, of which 23 were positive lymph nodes. The degree of lymph node metastasis was 16.9% (23 / 136), 86 lymph nodes were dissected in subgroup 6i, and the lymph nodes were (0.50 卤1.2), 16 (18.6%) and (0.93 卤1.07) lymph nodes were dissected in subgroup 6v, and the lymph node metastasis was 18.6% (16 / 86) in subgroup 6v, there were (0.93 卤1.07) lymph nodes per case in subgroup 6i. There were 22 metastatic lymph nodes (25.0%) (22 / 88). There was no significant difference in lymph node metastasis among the three subgroups (P < 0.342) .2The univariate analysis of lymph node metastasis in 6 groups showed that the lymph node metastasis and tumor size in 6 groups. The degree of differentiation was correlated with age, sex, location of tumor, depth of invasion (T stage) (p0.05), and lymph nodes in group 3 (p0.001), 4d (p0.001), 8a (p0.001), 9 (p0.001) and 12 (p0.001) in group 3 (p0.001) and group 3 (p0.001) respectively, and there was no correlation between the degree of differentiation of the tumor and age, sex, tumor location, depth of tumor invasion (T stage), and 3 groups (p0.001), 4sb group (p0.001), 4d (p0.001), 8a group (p0.001), 9 group (p0.001) and 12 groups (p0.001). 鍜，
本文编号：2243183
[Abstract]:Objective: lymphatic metastasis is the main metastasis pathway of gastric cancer. The clinical and pathological factors influencing lymph node metastasis in subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed in this study. To investigate the status of lymph node metastasis in 14v group under 6 groups of lymph node metastasis and the influence of dissection of 14 v group on the prognosis of the patients. Methods: the clinical pathophysiological data of 398 patients undergoing radical gastrectomy (D2 or D1) in the first affiliated Hospital of Dalian Medical University from January 2013 to December 2015 were retrospectively collected. The patients with subpyloric area (group 6) were screened out, and the clinicopathological factors affecting the metastasis of subpyloric region (group 6) and its three subgroups (6aAX 6v) were analyzed, and the status of lymph node metastasis in group 14v with subpyloric lymph node metastasis was discussed. And the effect of lymph node dissection on the prognosis of patients. Results among 1398 patients, 181 cases were dissected from 6 groups of lymph node metastases, and 53 cases (.6a) were involved in 53 cases of lymph node metastasis. The metastasis rate was 35.8% (19 / 53). There were 14 cases of lymph node metastasis. The metastatic rate was 26.4% (14 / 53) and the metastatic rate was 22.6% (9 / 53) in 20 patients with 6v lymph node metastasis, 136 lymph nodes were dissected in subgroup 6a, and (1.86 卤2.54) lymph nodes were obtained in each patient, of which 23 were positive lymph nodes. The degree of lymph node metastasis was 16.9% (23 / 136), 86 lymph nodes were dissected in subgroup 6i, and the lymph nodes were (0.50 卤1.2), 16 (18.6%) and (0.93 卤1.07) lymph nodes were dissected in subgroup 6v, and the lymph node metastasis was 18.6% (16 / 86) in subgroup 6v, there were (0.93 卤1.07) lymph nodes per case in subgroup 6i. There were 22 metastatic lymph nodes (25.0%) (22 / 88). There was no significant difference in lymph node metastasis among the three subgroups (P < 0.342) .2The univariate analysis of lymph node metastasis in 6 groups showed that the lymph node metastasis and tumor size in 6 groups. The degree of differentiation was correlated with age, sex, location of tumor, depth of invasion (T stage) (p0.05), and lymph nodes in group 3 (p0.001), 4d (p0.001), 8a (p0.001), 9 (p0.001) and 12 (p0.001) in group 3 (p0.001) and group 3 (p0.001) respectively, and there was no correlation between the degree of differentiation of the tumor and age, sex, tumor location, depth of tumor invasion (T stage), and 3 groups (p0.001), 4sb group (p0.001), 4d (p0.001), 8a group (p0.001), 9 group (p0.001) and 12 groups (p0.001). 鍜，
本文编号：2243183
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