论文部分内容阅读
目的胃癌是我国主要癌症种类之一,对人民身体健康与社会经济发展造成严重危害,而中上部胃癌因其自身特点,相关诊断、治疗及预后评价研究成为胃癌临床研究的热点与难点,故分析进展期中上部胃癌行保脾根治术患者第10组淋巴结(脾门淋巴结)转移的危险因素及对预后的影响。方法收集我院2008-06-01-2012-08-31行保留脾脏根治性手术治疗的243例中上部胃癌患者的临床病理资料及术后随访数据,按有无第10组淋巴结转移分为阳性组(21例)和阴性组(222例),分析第10组淋巴结转移的危险因素及其对预后的影响。结果全组患者的第10组淋巴结转移率为8.6%(21/243),两组患者的性别、年龄、术前血清癌胚抗原(carcino-embryonic antigen,CEA)值、肿瘤纵向位置、Lauren分型、神经侵犯相比差异均无统计学意义,均P>0.05;术前血清CA72-4值、肿瘤直径、肿瘤横向位置、Borrmann分型、肿瘤侵润深度(T分期)、转移淋巴结个数(N分期)、TNM分期、分化程度、脉管侵犯及胃周癌结节形成与中上部胃癌第10组淋巴结转移均具有相关性,均P<0.05。第10组淋巴结阳性组和阴性组3年总生存率(overall survival,OS)分别为12.6%和61.3%,χ2=21.934,P<0.001;2年无瘤生存率(disease-free survival,DFS)分别为15.9%和70.0%,χ2=34.868,P<0.001。第10组淋巴结转移的患者预后不良。Cox回归分析显示,肿瘤侵润深度T4、TNM分期ⅢC期、胃周癌结节形成及第10组淋巴结转移(HR=2.777,P=0.041,95%CI:1.042~7.404)与中上部胃癌行保留脾脏根治术的患者生存时间密切相关,均P<0.05。结论进展期中上部胃癌患者,肿瘤侵润深度T4、TNM分期ⅢC期、胃周癌结节形成及第10组淋巴结转移是中上部胃癌保脾根治术患者3年生存率低的独立危险因素。
Purpose Gastric cancer is one of the major types of cancer in our country, which causes serious harm to people’s health and social economic development. However, the research on the diagnosis, treatment and prognosis of middle and upper gastric cancer has become a hot and difficult point in the clinical research of gastric cancer. Risk factors for metastasis of group 10 lymph nodes (splenic lymph nodes) in patients with advanced upper gastric cancer undergoing spleen conservation therapy and their effect on prognosis. Methods The clinical and pathological data and postoperative follow-up data of 243 patients with upper gastric cancer who retained radical splenectomy in our hospital from 2008-06-01 to 2012-08-31 were divided into positive group (21 cases) and negative group (222 cases). The risk factors of lymph node metastasis in group 10 and its prognosis were analyzed. Results The lymph node metastasis rate of group 10 was 8.6% (21/243). The gender, age, preoperative serum carcinoembryonic antigen (CEA) value, tumor longitudinal position, Lauren score (P> 0.05). Preoperative serum CA72-4 value, tumor diameter, transverse tumor location, Borrmann classification, tumor invasion depth (T stage), the number of metastatic lymph nodes (Stage N), TNM stage, degree of differentiation, vascular invasion and gastric cancer nodules were associated with lymph node metastasis in group 10 of middle and upper gastric cancer, both P <0.05. The 3-year overall survival (OS) of lymph node positive group and negative group in group 10 were 12.6% and 61.3%, respectively, χ2 = 21.934, P <0.001; 2 year disease-free survival (DFS) 15.9% and 70.0% respectively, χ2 = 34.868, P <0.001. Patients in group 10 lymph node metastasis have a poor prognosis. Cox regression analysis showed that the tumor invasion depth T4, TNM stage Ⅲ C, gastric cancer nodule formation and lymph node metastasis of group 10 (HR = 2.777, P = 0.041, 95% CI: 1.042-7.404) Survival time of patients with spleen radical surgery was closely related, all P <0.05. Conclusions The patients with advanced upper gastric cancer, the depth of tumor invasion T4, TNM stage Ⅲ C, gastric cancer nodules and lymph node metastasis of group 10 are the independent risk factors for the low 3-year survival rate.