Background: Surgery is the preferred treatment of early gastric cancer (EGC), and the presence of lymph node metastasis (LNM) is a significant prognostic factor for patients with EGC. Lymph node dissection might diminish the risk of postoperative recurrence, however, excessive dissection would worsen the quality of life of patients with EGC. Aims: To analyze the independent risk factors for LNM in EGC. Methods: A total of 376 cases of EGC were recruited in this retrospective study. These patients underwent curative gastrectomy from Jan. 1982 to Feb. 2009 in Shanghai Changning District Central Hospital, and more than 15 nodes were retrieved in each patient. Relations of gender, age and six clinicopathological characteristics with LNM were analyzed. Results: Univariate analysis showed that tumor size ≥2 cm,protrude type, submucosal invasion, poorly-differentiated and lymphatic vascular involvement were correlated with LNM in EGC, while no statistical relationship was found for gender, age and tumor location. Multivariate logistic regression showed that tumor size, depth of invasion, and degree of differentiation were independent risk factors for LNM in EGC.Conclusions: The status of lymph node, tumor size, depth of invasion and histological type of EGC can be defined by preoperative endoscopic ultrasound, CT and biopsy histology. Based on these examinations, the presence of LNM might be presumed, which will be helpful for choosing operation scheme and extent of lymph node dissection.%背景:手术是早期胃癌的首选治疗方法.淋巴结转移是早期胃癌的关键预后因素,术中淋巴结清扫虽可降低术后复发率,但清扫过度可能导致患者术后生活质量降低.目的:分析早期胃癌淋巴结转移的独立危险因素.方法:1982年1月～2009年2月于上海市长宁区中心医院行胃癌根治术且淋巴结清扫＞15枚的376例早期胃癌患者纳入研究,分析性别、年龄以及6项肿瘤临床病理特征与淋巴结转移之间的关系.结果:单因素分析显示,肿瘤≥2cm、大体类型为隆起型、黏膜下浸润、分化差和有淋巴管癌栓与早期胃癌淋巴结转移有关,而性别、年龄和肿瘤部位与淋巴结转移之间无明显相关性.多因素logistic回归显示肿瘤大小、浸润深度和分化程度是早期胃癌淋巴结转移的独立危险因素.结论:临床医师术前可通过内镜超声、CT和活检病理检查确定早期胃癌的淋巴结肿大情况以及肿瘤大小、浸润深度和组织学类型,据此推测有无淋巴结转移倾向,从而选择合理的手术方式和术中淋巴结清扫范围.
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