157例早期胃癌淋巴结转移特点及预后分析

目的探讨早期胃癌（EGC）临床病理特征和淋巴结转移规律及其对预后的影响。方法回顾性分析1995年10月至2005年10月间经手术治疗的157例EGC的临床病理特征和淋巴结转移规律及患者3年、5年的生存率。结果157例EGC患者有22例（14％）伴有淋巴结转移，其中黏膜癌2例（2.4％），仅累及N1淋巴结；黏膜下癌20例（27．0％），除累及N1淋巴结外，有7例同时累及N2淋巴结；两者比较，差异有统计学意义（P〈0．01）。微小胃癌（直径小于或等于0．5cm）者未见有淋巴结转移：直径小于或等于2．0cm和大于2．0cm的胃癌患者．淋巴结转移率分别为6.4％和21．5％；两者比较，差异有统计学意义（P〈0．01）。高分化EGC未见淋巴结转移；中分化及低分化EGC的淋巴结转移率分别为11．1％和20．9％；两者比较，差异有统计学意义（P〈0．01）。有9例出现脉管癌栓．其中4例伴淋巴结转移。Logistic回归多因素分析结果显示，肿瘤大小、分化程度、浸润深度、脉管癌栓均为影响EGC淋巴结转移的独立因素。伴有淋巴结转移的EGC患者3年、5年生存率分别为81．6％和79．5％，明显低于无淋巴结转移者的95．7％和93．2％（P〈0．01）。结论EGC的淋巴结转移主要与肿瘤浸润深度、肿瘤大小、脉管癌栓及肿瘤分化程度密切相关。应根据淋巴结转移的风险合理选择EGC的治疗方式。

Characteristics of lymph node metastasis and prognostic analysis in 157 early gastric cancer patients

Objective To explore the pattern of lymph node metastasis and its influence on the prognosis of early gastric cancer(EGC). Methods The pattern of lymph node metastasis and the 3-,5-year survival rates in 157 EGC patients undergone surgery from October 1995 to October 2005 were analyzed retrospectively. The SPSS 11.5 statistics software was used to perform univariate and multivariate analysis. Results Twenty-two cases had lymph node metastasis among 157 EGC patients (14%). Two mucous cancers (2.4%) and 20 submucosal tumors (27.0%) had lymph node metastases (P<0.01). Lymph node metastasis was not seen in minute gastric cancer (diameter ≤0.5 cm). Lymph node metastasis rates were 6.4% in the cancers with diameter 1.1-2.0 cm and 21.5% in the cancers with the diameter >2.0 cm (P<0.01). Besides, lymph node metastasis rate of well-differentiated EGC was O, of moderate differentiated EGC 11.1%, and poor-differentiated EGC 0.9% (P<0.01). Of 9 cases with vascular cancer embolus, 4 had lymph node metastases. Logistic regression analysis showed that tumor size, vascular cancer embolus, histopathological type and depth of invasion were independent factors of lymph node metastasis in EGC. The 3- and 5-year survival rates of EGC patients with lymph node metastasis were 81.6 % and 79.5% respectively,which were much lower than those without lymph node metastasis (95.7% and 93.2%, P<0.01).Conclusions Lymph node metastasis in EGC is mainly correlated with depth of infiltration, tumor size,vascular cancer embolus and differentiation. For EGC treatment, choice should be made reasonably based on the risk of lymph node metastasis.