早期近、远端胃癌淋巴结转移差异以及内镜下切除指征的探讨

摘要

背景:近年远端胃癌的发病率显著下降,但近端胃癌的发病率呈上升的趋势.研究发现近、远端胃癌的临床病理特征存在明显差异.目的:探讨早期近、远端胃癌淋巴结转移差异以及内镜下治疗的指征.方法:回顾性分析2013年6月—2016年6月南京大学医学院附属鼓楼医院行胃癌根治术的420例早期胃癌(近端101例,远端319例)患者的临床资料,比较早期近、远端胃癌的临床病理特征,并分析淋巴结转移的危险因素.结果:早期近端胃癌患者的性别、年龄、组织分化程度、是否合并溃疡、淋巴结转移与早期远端胃癌患者相比差异均有统计学意义(P<0.05).单因素分析显示肿瘤部位、肿瘤大小、浸润深度、组织分化程度和脉管浸润与淋巴结转移显著相关(P<0.05);多因素分析显示肿瘤部位、浸润深度、组织分化程度、脉管浸润为淋巴结转移的独立危险因素(P<0.05).联合上述4个独立危险因素分析显示黏膜内、分化型、无脉管浸润的近端胃癌淋巴结转移率为2.8%,低于远端胃癌(8.3%).结论:早期近端胃癌的临床病理特征与早期远端胃癌存在明显差异,黏膜内、分化型、无脉管浸润的近端胃癌患者更适合行内镜下切除.%Background:In recent years,a rising incidence of proximal gastric cancer(PGC)has been reported,in contrast to a declining trend of distal gastric cancer(DGC). Differences in clinicopathological features between PGC and DGC have also been reported. Aims:To investigate the differences of lymph node metastasis between early PGC and DGC and the indication of endoscopic resection. Methods:The clinical data of 420 early gastric cancer patients(101 PGC patients and 319 DGC patients)who underwent curative gastrectomy from June 2013 to June 2016 at the Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed. Clinicopathological features were compared between early PGC and DGC,and risk factors of lymph node metastasis were analyzed. Results:The differences in gender,age, histological differentiation,ulceration and lymph node metastasis were significant between early PDG and DGC patients (P<0.05). Tumor site,tumor size,depth of invasion,histological differentiation and vascular invasion were significantly correlated with lymph node metastasis by univariate analysis(P<0.05). Multivariate analysis revealed that tumor site, depth of invasion,histological differentiation and vascular invasion were independent risk factors for lymph node metastasis (P<0.05). The lymph node metastasis rate of mucosal,differentiated and vascular invasion negative PGC was 2.8%, which was lower than that of DGC(8.3%). Conclusions:The clinicopathological features of early PGC are different from those of early DGC. Patients with mucosal,differentiated and vascular invasion negative PGC are more suitable for endoscopic resection.