目的探讨食管胃交界部癌(carcinoma of esophagogastric junction,CEJ)发生腹腔及胸腔纵隔淋巴结转移的危险因素,以指导是否清扫胸腔纵隔淋巴结。方法采用回顾性研究分析行食管胃交界部癌根治术的217例患者,分析术前胃镜及术后病理检查...目的探讨食管胃交界部癌(carcinoma of esophagogastric junction,CEJ)发生腹腔及胸腔纵隔淋巴结转移的危险因素,以指导是否清扫胸腔纵隔淋巴结。方法采用回顾性研究分析行食管胃交界部癌根治术的217例患者,分析术前胃镜及术后病理检查结果。结果淋巴结转移阳性数目是发生胸腔纵隔淋巴结转移独立的危险因素,且淋巴结转移数目每增加1个,纵隔淋巴结发生转移风险增加34.0%(OR=1.340,95%CI:1.090~1.648;P=0.006);脉管瘤栓(OR=5.83,95%CI:1.65~20.62,P=0.006)、浸润深度T(OR=2.35,95%CI:1.30~4.24,P=0.005)和上侵食管长度(OR=1.29,95%CI:1.02~1.63,P=0.033)是发生腹腔淋巴结转移的独立危险因素,而且上侵及食管每增加1 cm,发生腹腔淋巴结转移的风险增加29.0%。结论浸润深度越深、存在脉管瘤栓且上侵及食管越多的食管胃交界部癌患者发生腹腔淋巴结转移的风险越高。淋巴结转移数目越多,纵隔淋巴结发生转移的风险加大。展开更多
AIM:To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach.METHODS:We retrospectively analyzed the clinical records of 430 patients with advanced gas...AIM:To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach.METHODS:We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004.Receiver-operating characteristic(ROC)curve analysis was used to determine the appropriate cutoff value for tumor size,which was measured as maximum tumor diameter.Based on this cutoff value,patients were divided into two groups:those with large-sized tumors(LSTs)and those with small-sized tumors(SSTs).The correlations between other clinicopathologic factors and tumor size were investigated,and the 5-year overall survival(OS)rate was compared between the two groups.Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis.The 5-year OS rates in the two groups were compared according to pT stage and pN stage.RESULTS:The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%.The mean±SD tumor size was 4.9±1.9 cm,and the median tumor size was 5.0 cm.ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0%and 68.2%,respectively(AUC=0.795,95%CI:0.751-0.839,P=0.000).Using this cutoff value,222 patients(51.6%)had LSTs(tumor size≥4.8 cm)and 208(48.4%)had SSTs(tumor size<4.8 cm).Tumor size was significantly correlated with histological type(P=0.039),Borrmann type(P=0.000),depth of tumor invasion(P=0.000),lymph node metastasis(P=0.000),tumor-nodes metastasis stage(P=0.000),mean number of metastatic lymph nodes(P=0.000)and metastatic lymph node ratio(P=0.000).Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs(37.1%vs 63.3%,P=0.000).Univariate analysis showed that depth of tumor invasion(c 2=69.581,P=0.000),lymph node metastasis(c 2=138.815,P=0.000),tumor size(c 2=78.184,P=0.000)and metastatic lymph node ratio(c 2=139.034,P=0.000)were significantly associated with 5-year OS rate.Multivariate analysis revealed that depth of tumor invasion(P=0.000),lymph node metastasis(P=0.019)and tumor size(P=0.000)were independent prognostic factors.Gastric cancers were divided into 12 subgroups:pT2N0;pT2N1;pT2N2;pT2N3;pT3N0;pT3N1;pT3N2;pT3N3;pT4aN0;pT4aN1;pT4aN2;and pT4aN3.In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors,5-year OS rates were significantly lower for LSTs than for SSTs(P<0.05 each),but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors(P>0.05).CONCLUSION:Using a tumor size cutoff value of 4.8cm,tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.展开更多
文摘目的探讨食管胃交界部癌(carcinoma of esophagogastric junction,CEJ)发生腹腔及胸腔纵隔淋巴结转移的危险因素,以指导是否清扫胸腔纵隔淋巴结。方法采用回顾性研究分析行食管胃交界部癌根治术的217例患者,分析术前胃镜及术后病理检查结果。结果淋巴结转移阳性数目是发生胸腔纵隔淋巴结转移独立的危险因素,且淋巴结转移数目每增加1个,纵隔淋巴结发生转移风险增加34.0%(OR=1.340,95%CI:1.090~1.648;P=0.006);脉管瘤栓(OR=5.83,95%CI:1.65~20.62,P=0.006)、浸润深度T(OR=2.35,95%CI:1.30~4.24,P=0.005)和上侵食管长度(OR=1.29,95%CI:1.02~1.63,P=0.033)是发生腹腔淋巴结转移的独立危险因素,而且上侵及食管每增加1 cm,发生腹腔淋巴结转移的风险增加29.0%。结论浸润深度越深、存在脉管瘤栓且上侵及食管越多的食管胃交界部癌患者发生腹腔淋巴结转移的风险越高。淋巴结转移数目越多,纵隔淋巴结发生转移的风险加大。
文摘AIM:To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach.METHODS:We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004.Receiver-operating characteristic(ROC)curve analysis was used to determine the appropriate cutoff value for tumor size,which was measured as maximum tumor diameter.Based on this cutoff value,patients were divided into two groups:those with large-sized tumors(LSTs)and those with small-sized tumors(SSTs).The correlations between other clinicopathologic factors and tumor size were investigated,and the 5-year overall survival(OS)rate was compared between the two groups.Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis.The 5-year OS rates in the two groups were compared according to pT stage and pN stage.RESULTS:The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%.The mean±SD tumor size was 4.9±1.9 cm,and the median tumor size was 5.0 cm.ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0%and 68.2%,respectively(AUC=0.795,95%CI:0.751-0.839,P=0.000).Using this cutoff value,222 patients(51.6%)had LSTs(tumor size≥4.8 cm)and 208(48.4%)had SSTs(tumor size<4.8 cm).Tumor size was significantly correlated with histological type(P=0.039),Borrmann type(P=0.000),depth of tumor invasion(P=0.000),lymph node metastasis(P=0.000),tumor-nodes metastasis stage(P=0.000),mean number of metastatic lymph nodes(P=0.000)and metastatic lymph node ratio(P=0.000).Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs(37.1%vs 63.3%,P=0.000).Univariate analysis showed that depth of tumor invasion(c 2=69.581,P=0.000),lymph node metastasis(c 2=138.815,P=0.000),tumor size(c 2=78.184,P=0.000)and metastatic lymph node ratio(c 2=139.034,P=0.000)were significantly associated with 5-year OS rate.Multivariate analysis revealed that depth of tumor invasion(P=0.000),lymph node metastasis(P=0.019)and tumor size(P=0.000)were independent prognostic factors.Gastric cancers were divided into 12 subgroups:pT2N0;pT2N1;pT2N2;pT2N3;pT3N0;pT3N1;pT3N2;pT3N3;pT4aN0;pT4aN1;pT4aN2;and pT4aN3.In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors,5-year OS rates were significantly lower for LSTs than for SSTs(P<0.05 each),but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors(P>0.05).CONCLUSION:Using a tumor size cutoff value of 4.8cm,tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.
