摘要
目的探讨进展期胃底贲门癌镜检转移阴性淋巴结数目对预后的影响。方法对236例进展期胃底贲门癌患者施行D2根治术，根据镜检转移阴性淋巴结数目进行分组，分析转移阴性淋巴结数目与术后5年生存率、复发率间的关系。结果236例进展期胃底贲门癌患者术后5年生存率为37．5％。转移阴性淋巴结的数目与清扫淋巴结总数呈正相关（P〈0.05）。同一病期，转移阴性淋巴结的数目越多，术后5年生存率越高，差异具有统计学意义（P〈0．05）。线性回归预测，随着转移阴性淋巴结数目的增加，术后生存率可得到不同程度的提高，Ⅲ期和Ⅳ期的回归系数差异均具有统计学意义（均P〈0.05）。术后5年总体复发率为61．0％，Ⅲ期、Ⅳ期患者转移阴性淋巴结数目越多，术后复发率越低，总体差异均具有统计学意义（P〈0．05）。结论转移阴性淋巴结数目可反映淋巴结清扫的程度和预后。进展期胃底贲门癌患者在施行D2根治术时，应积极争取清扫足够的转移阴性淋巴结，以提高疗效，降低术后复发率。
Objective To analyze the impact of negative lymph node number on the prognosis of advanced cancer of the cardia and stomach fundus, Methods 236 patients with advanced cancer of the cardia and stomach fundus underwent D2 radical resection. 5-year survival rate and recurrence rate were followed up and the relationships of lymph node （ LN ） number to 5-year survival rate and recurrence rate were analyzed respectively, according to LN count subgroups. Results The 5-year survival rate of the entire cohort was 37.5%. The number of metastasis negative LNs was positively correlated with the LNs examined （ P 〈 O. 05 ）. For the cancer at the same stage, the higher the number of metastasis negative LNs the higher the 5-year survival rate （ P 〈 O. 05 ）. Linear correlation analysis showed that along with the increase of the number of negative LNs the post-operative survival rate increased. In the cancers at the stages Ⅲ and Ⅳ, the 5-year survival rate increased by 6.09% and 7.65% respectively compared to the predicted values （ P = O. 013 and P =0. 035）. The overall recurrence rate was 61.0% within 5 years after surgery. For the cancers at the stages Ⅲ and Ⅳ, the more the number of negative LNs the higher the 5-year survival rates （ P 〈 O. 05 ）. In the cancers at the stages Ⅲ and Ⅳ there were significant differences in the recurrence rates among the subgroups with different numbers of negative LNs （ all P 〈 O. 002 ）. Conclusion Number of negative LNs has a close relation with stage-based survival prediction. Dissection of sufficient lymph nodes in the procedure of D2 dissection should be recommended so as to improve the long-term therapeutic effects and reduce the recurrence rate.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第19期1327-1330,共4页
National Medical Journal of China
关键词
胃肿瘤
淋巴结
肿瘤转移
淋巴结切除术
预后
Stomach neoplasms
Lymph nodes
Neoplasm metastasis
Lymph node excision
Prognosis
