中国普外基础与临床杂志

中国普外基础与临床杂志

早期胃癌淋巴结转移的相关危险因素分析

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目的 探讨早期胃癌淋巴结转移的相关危险因素,为合理制定治疗方案提供依据。 方法 对安徽省肿瘤医院腹部肿瘤外科于 2013 年 2 月至 2017 年 11 月期间行胃癌根治术的 148 例早期胃癌患者的临床病理资料进行回顾性研究,对患者的年龄、性别,肿瘤的大小、位置、大体分型、组织学类型、浸润深度及是否有脉管神经侵犯与淋巴结转移的关系进行单因素及多因素分析。 结果 148 例患者中有 15 例发生淋巴结转移(10.14%),其中黏膜内癌的淋巴结转移率为 1.43%(1/70),黏膜下层癌的淋巴结转移率为 17.95%(14/78)。单因素分析结果显示,早期胃癌患者的年龄、肿瘤大体类型、肿瘤大小、肿瘤浸润深度及脉管神经侵犯情况与早期胃癌患者的淋巴结转移有关(P<0.050);logistic 回归分析结果显示,肿瘤浸润深度和脉管神经侵犯是早期胃癌发生淋巴结转移的独立危险因素(P<0.050)。 结论 肿瘤浸润深度及脉管神经侵犯与早期胃癌淋巴结转移密切相关,术前正确评估淋巴结转移情况对治疗方式选择及患者预后至关重要。

Objective To analyze risk factors of lymphatic metastasis in early gastric cancer in order to discuss reasonable therapeutic regimen. Methods The clinical data of 148 patients with early gastric cancer surgically treated in the AnHui Tumor Hospital from February 2013 to November 2017 were retrospectively analyzed. The relationship of the lymphatic metastasis with the clinicopathologic characteristics of the patient with the early gastric cancer was analyzed by the univariate and multiple regression analyses. Results The lymphatic metastasis was observed in 15 of 148 patients (10.14%), 1 in 70 (1.43%) the mucosal lesions and 14 in 78 (17.95%) the submucosal lesions. The results of the univariate analysis showed that the patients’ age, size of tumor, macroscopic type, invasion depth, and vascular invasion were related to the lymphatic metastasis in the early gastric cancer (P<0.050), the results of the multiple regression analysis showed that the invasion depth and vascular invasion were the independent risk factors of the lymphatic metastasis in the early gastric cancer (P<0.050). Conclusions Invasion depth and vascular invasion are closely related to lymphatic metastasis in early gastric cancer. Precise evaluation of lymphatic metastasis before treatment is very important to patient with early gastric cancer.

关键词: 早期胃癌; 淋巴结转移; 危险因素; 治疗方式

Key words: early gastric cancer; lymphatic metastasis; risk factor; therapeutic option

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1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma-2nd English Edition. Gastric Cancer, 1998, 1(1): 10-24.
2. Soetikno R, Kaltenbach T, Yeh R, et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol, 2005, 23(20): 4490-4498.
3. Tan D, Lauwers GY. Advances in surgical pathology//Gastric cancer. Philadelphia: Lippincott Williams & Wilkins, 2011: 73.
4. Ono H. Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes. Eur J Gastroenterol Hepatol, 2006, 18(8): 863-866.
5. 王浩, 周岩冰, 牛兆建, 等. 早期胃癌预后及复发转移因素分析. 中华普通外科杂志, 2015, 30(8): 639-642.
6. 王永向, 高亮, 王元宇, 等. 早期胃癌预后的影响因素分析. 中华胃肠外科杂志, 2014,17(2): 180-181.
7. Saka M, Katai H, Fukagawa T, et al. Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer, 2008, 11(4): 214-218.
8. Kwee RM, Kwee TC. Predicting lymph node status in early gastric cancer. Gastric Cancer, 2008, 11(3): 134-148.
9. Shen ZL, Song KY, Ye YJ, et al. Significant differences in the clinicopathological characteristics and survival of gastric cancer patients from two cancer centers in china and Korea. J Gastric Cancer, 2015, 15(1): 19-28.
10. 刘国栋, 李晓波, 李昌荣, 等. 早期胃癌淋巴结转移的研究进展. 中华消化外科杂志, 2016, 15(1): 93-96.
11. 程巍, 高顺良. 老年胃癌的诊疗进展. 浙江创伤外科, 2016, 21(4): 809-812.
12. 荆晓岳, 王建国, 周兵, 等. 10年豫北地区胃癌临床流行病学特征. 中国普外基础与临床杂志, 2010, 17(1): 29-33.
13. 王力, 梁寒, 王晓娜, 等. 早期胃癌淋巴结转移规律及影响因素. 中华胃肠外科杂志, 2013, 16(2): 147-150.
14. 邹振玉, 沈笛, 杜晓辉, 等. 早期胃癌淋巴结转移相关因素和淋巴结清扫范围的探讨. 中华普通外科杂志, 2016, 31(6): 456-459.
15. 徐静, 项锋钢, 王宁. 胃癌微淋巴管的增殖状态及分布特点. 青岛大学医学院学报, 2007, 43(6): 473-476.
16. 戴冬秋, 张春东. 早期胃癌的外科治疗策略. 医学与哲学, 2016, 37(4): 8-11.
17. 刘岚, 王云霞, 郭建强. 内镜黏膜下剥离术和内镜下黏膜切除术治疗早期胃癌的Meta分析. 中国老年学杂志, 2015, 35(7): 1804-1808.
18. 彭志华. 早期胃癌行内镜黏膜下剥离术的有效性与可行性分析. 现代中西医结合杂志, 2015, 27(24): 2986-2988.
19. 李忠武. 早期胃癌规范化诊治流程及预后因素. 临床与病理杂志, 2015, 35(6): 928-932.
20. Lian J, Chen S, Zhang Y, et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc, 2012, 76(4): 763-770.
21. 所剑, 王大广, 刘泽锋. 早期胃癌诊断和治疗. 中国实用外科杂志, 2011,31(8): 717-719.
22. 谢洪虎, 吕成余, 陈维, 等. 958例胃癌临床病理资料分析. 中国普外基础与临床杂志, 2011, 18(2): 153-158.
23. Fujii M, Egashira Y, Akutagawa H, et al. Pathological factors related to lymph node metastasis of submucosally invasive gastric cancer: criteria for additional gastrectomy after endoscopic resection. Gastric Cancer, 2013, 16(4): 521-530.
24. An JY, Baik YH, Choi MG, et al. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg, 2007, 246(5): 749-753.
25. 范晓飞, 戈之铮, 高云杰, 等. 早期胃癌淋巴结转移规律及内镜切除指征的探讨. 中华消化内镜杂志, 2013, 30(11): 626-630.
26. 娄乔, 练晶晶, 曾晓清, 等. 早期胃癌473例淋巴结转移与临床病理特征相关性分析. 中华消化杂志, 2015, 35(1): 19-21.
27. 蒋楠, 邓靖宇, 刘勇, 等. 淋巴结转移阴性的低分化和未分化胃腺癌的预后因素分析. 中华消化外科杂志, 2014, 13(8): 629-632.
28. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010(ver. 3). Gastric Cancer, 2011, 14(2): 113-123.