摘要
目的探讨淋巴结转移率（rN）在胃癌患者预后评估中的价值。方法对比分析319例接受胃癌根治术且清扫的淋巴结总数大于或等于15枚胃癌患者的临床资料，探讨rN与胃癌预后的关系。结果本研究中将rN按0、〈30％、30％～60％及〉60％分为4组，各组2年生存率分别为84．4％、66．1％、35．0％、15．1％；3年生存率分别为80．5％、45．0％、15．0％、5．5％；4年生存率分别为71．4％、33．0％、5．0％、1．4％，差异均有统计学意义（P〈0．05），与预后有良好的一致性。将同一pN分期组与rN分组比较，各组预后之间的差异均无统计学意义。COX多因素分析结果显示rN是影响胃癌预后的独立指标，其与肿瘤浸润深度、手术方式及肿瘤部位有相关性。结论rN分级可更好地指导胃癌的治疗和预后判断，有助于完善胃癌的TNM分期体系。
Objective To evaluate the prognostic significance of metastastic lymph node ratio in patients with gastric cancer. Methods Clinical data of 319 patients with gastric cancer who underwent radical gastrectomy with at least 15 lymph nodes dissected per patient were analyzed retrospectively. Patients were divided into 4 groups according to the TNM staging system （1997, 5th edition）： pNO （no positive lymph node）, pN1 （with 1 ～ 6 metastatic lymph nodes）, pN2 group （with 7 ～ 15 metastatic lymph nodes）, and pN3 group （with more than 15 metastatic lymph nodes）, or into 4 groups according to the lymph node metastatic ratio： rNO group （without metastasis of lymph node）, rN1 group （with a lymph node metastatic ratio of 〈 30% ）, rN2 group （ with a lymph node metastatic ratio of 30% ～ 60% ）, and rN3 group （ with a lymph node metastatic ratio of 〉 60% ）. Survival was determined by the Kaplan-Meier method and differences were assessed by the Log-rank test. Multivariate analysis was performed using the COX proportional hazard regression model in forward stepwise regression with SPSS 13. 0. Results Kaplan-Meier survival analysis demonstrated that the metastatic lymph node ratio significantly influenced the postoperative survival time. According to the lymph node metastasis system 77 patients were in group 1, 109 in group 2, 60 in group 3, and 73 in group 4. The 2-year survival rate was 84. 4% , 66. 1% , 35.0% , and 15. 1% respectively, 3-year survival rate was 80. 5% ,45.0% , 15.0% and 5.5% respectively, and 4-year survival rate was 71.4% ,33.0% ,5.0% and 1.4% respectively. If cases with the same positive number of lymph node （pN） group were stratified futher by lymph node metastatic ratio, there were no significant differences in the 3-year survival rate among the new rN groups （ P 〉 0. 05 ） , but there was a great difference in the distribution of prognosis among different groups. COX proportional hazard regression model analysis showed that the metastatic lymph node ratio was an independent factor for poor prognosis. Lymph node metastatic ratio was closely related with the location, modality of the operation and infiltration depth. Conclusions The staging system based on metastatic lymph node ratio is more reliable than the system based on the number of metastatic lymph nodes in the prediction of the prognosis of gastric cancer.
出处
《中华普通外科杂志》
CSCD
北大核心
2008年第6期411-415,共5页
Chinese Journal of General Surgery
关键词
胃肿瘤
淋巴转移
肿瘤分期
预后
Stomach neoplasms
Lymphatic metastasis
Neoplasm staging
Prognosis
