分化不良型早期胃癌淋巴结转移的多因素分析

摘要

Objective The present study analyzes the law of lymphatic metastasis in patients with poorly differentiated early gastric cancer and provides a basis for minimally invasive treatment and narrow operative range. Methods The clinical data of 301 patients suffering from poorly differentiated early gastric cancer were retrospectively analyzed. These patients were admitted to and treated in the Chinese PLA General Hospital from September 1983 to June 2010. Lymph nodes were found in 294 patients after radical resection. Univariate. multivariate. and chromatographic analyses were done to analyze the effect of the following nine clinicopathological variables: age, gender, tumor size, location, macroscopic type, depth of invasion, lymphatic vessel involvement, smoking, and tumor family history. Results The incidence rate of lymphatic metastasis in poorly differentiated early gastric cancer was 19. 0% (56/294), from which the incidence rates of lymphatic metastasis for mucosal (M) and submucosal (SM) cancer were 4. 4% (6/136) and 31. 6% (50/158). The logistic regression analysis showed that tumor sizes of >1. 5 cm (P= 0.049, OR = 2. 437), submucosal invasion (P= 0.000, OR = 6.681), lymphatic vessel involvement (P= 0.000, OR = 8. 469) are independent risk factors for lymphatic metastasis. Moreover, the chromatographic analysis showed that M lymphatic metastasis was influenced by tumor size (P=0. 028) and lymphatic vessel involvement (P= 0.005), whereas SM lymphatic metastasis was influenced by lymphatic vessel involvement (P= 0.000). Conclusion Poorly differentiated M cancers without lymphatic metastasis with tumor sizes of ≤1. 5 cm can be cured via endoscopic microinvasive treatment, whereas for those with tumor sizes of >1. 5 cm, the operative range may be reduced.%目的 探讨分化不良型早期胃癌淋巴结转移的规律,为微创治疗、缩小手术范围提供依据.方法 对解放军总医院1983年9月-2010年7月收治的301例分化不良型早期胃癌患者进行回顾性分析,其中294例术后标本找到淋巴结.对上述患者年龄、性别、肿瘤大小、部位、大体类型、浸润深度、淋巴管癌栓、吸烟、肿瘤家族史对淋巴结转移的影响进行单因素、多因素及分层分析.结果 分化不良型早期胃癌淋巴结转移率为19.0％(56/294),其中黏膜(M)癌的淋巴结转移率为4.4％(6/136),黏膜下层(SM)癌的淋巴结转移率为31.6％(50/158).Logistic同归分析提示肿瘤＞1.5cm( P=0.049,OR=2.437)、浸润黏膜下层(P=0.000,OR=6.681)、淋巴管癌栓(P=0.000,OR=8.469)为淋巴结转移的独立危险因子.分层分析提示影响黏膜癌淋巴结转移的因素为肿瘤大小(P=0.028)和淋巴管癌栓(P=0.005),影响黏膜下层癌淋巴结转移的因素为淋巴管癌栓(P=0.000).结论 ≤1.5cm的分化不良型黏膜癌无淋巴结转移,可选择内镜下微创治疗;＞1.5cm、无淋巴管癌栓的分化不良型黏膜癌淋巴结转移率低,可选择缩小手术.