淋巴结转移对无浆膜浸润胃癌患者预后的影响

目的 探讨淋巴结转移对无浆膜浸润胃癌预后的影响.方法 回顾性分析1994年1月至2005年12月间大连医科大学附属第一医院普通外科行D2或D2以上胃癌根治术、且具有完整随访资料的616例无浆膜浸润胃癌患者的临床资料;并选取同期接受相同术式的有浆膜浸润的162例胃癌患者为对照组.结果 无浆膜浸润胃癌患者的5年生存率为77.9％,明显高于浆膜浸润组的37.3％（P＜0.01）.不同浸润深度患者5年生存率分别为T１a（M）95.6％,T1b（SM） 92.5％,T2（MP）73.5％,T3（SS） 62.7％,T4（SE、SI） 37.3％.按日本第13版《胃癌处理规约》,N0、N1（第1站）、N2（第2站）和N3（第3站）无浆膜浸润胃癌患者的5年生存率分别为91.5％、75.3％、54.8％和14.7％,差异有统计学意义（P＜0.01）;按第7版TNM分期,N0、N1（1～2枚）、N2（3～6枚）、N3a（7～15枚）和N3b（15枚以上）无浆膜浸润胃癌患者的5年生存率分别为91.5％、83.6％、59.8％、17.2％和11.8％,差异亦有统计学意义（P＜0.01）.淋巴结转移是无浆膜浸润胃癌患者预后的独立预后因素（P＜0.0l）.结论 无论是按转移淋巴结的范围还是数量进行评价,淋巴结转移均能对无浆膜浸润胃癌患者的预后作出较好的预测.

Lymph node metastasis and prognosis of gastric cancer without serosal invasion

Objective To evaluate the impact of lymph node metastasis on the prognosis of gastric cancer without serosal invasion.Methods From January 1994 to December 2005,616 gastric cancer patients without serosal invasion and 162 gastric cancer patients with serosal invasion underwent D2 or D2 ＋ lymphadenectomy.Clinicopathologic data and long-term survival of the two groups were analyzed retrospectively.Results The 5-year survival rate of patients with gastric cancer without serosal invasion was 77.9%,significantly higher than that of patients with gastric cancer with serosal invasion （37.3%）（P〈0.01）.The 5-year survival rates of T1a （M）,T1b （SM）,T2 （MP）,T3 （SS）,T4 （SE,SI）were 95.6%,92.5%,73.5%,62.7%,and 37.3%,respectively.As classified in the 13th edition of Gastric Cancer Treatment Guidelines in Japan,the 5-year survival rates of patients with gastric cancer without serosal invasion were 91.5% in NO,75.3% in N1,54.8% in N2,14.7% in N3,and the differences were statistically significant （P〈0.01）.According to 7th edition of TNM classification,the 5-year survival rates of NO,N1,N2,N3a,N3b for the study group were 91.5%,83.6%,59.8%,17.2%,11.8%,respectively （P〈0.01）.Lymph node metastasis was an independent prognostic risk factor （P〈0.01）.Conclusions In patients with gastric cancer without serosal invasion,lymph node metastasis is an predictive factor regardless it is based on the extent or the number of lymph node metastasis.