224例无淋巴结转移的进展期胃癌预后因素分析

目的探讨无淋巴结转移的进展期胃癌预后危险因素。方法回顾性分析福建省立医院1998—2008年10年间行D2胃癌根治术的236例淋巴结清扫数目在12枚以上、无淋巴结转移（N0期）的进展期胃癌患者的临床病理资料。结果本组患者中224例（94．9％）接受了随访，其5年总体生存率和5年无瘤生存率分别为75．2％和66．4％。T2期和T3期患者的复发率分别为5．8％（8／138）和14．0％（12／86）：5年总体生存率分别为82．5％和59．0％；5年无瘤生存率分别为70．4％和52．2％：差异均有统计学意义（均P〈0．05）。单因素预后分析显示，浸润深度、Lauren分型及淋巴结清扫数目与本组胃癌患者预后有关（P〈0．05）。多因素预后分析证实，浸润深度是本组患者的独立预后因素（P〈0．05）。结论T2N0期胃癌患者的预后明显优于T3N0期患者；对N0期胃癌患者决定是否行辅助治疗及制定随访策略时应考虑浸润深度这一因素。

Analysis of prognostic factors in lymph node-negative advanced gastric cancer patients

Objective To investigate the prognostic factors of lymph node-negative advanced gastric cancer patients in order to guide adjunctive therapy and surveillance tragedy. Methods A total of 236 advanced gastric cancer patients with no less than 12 retrieved lymph nodes and without lymph node metastasis from Fujian Provincial Hospital between 1998 and 2008 were collected retrospectively.Univariate and multivariate prognostic analysis were performed. Results Two hundred and twenty-four patients(94.9%) were followed up and 5-year overall and disease-free survival rates were 75.2% and 66.4% respectively. Univariate prognostic analysis showed that depth of infiltration, Lauren histotype and retrieved lymph nodes were associated with 5-year overall survival (all P＜0.05). Multivariate prognostic analysis testified that depth of infiltration was independent prognostic predictor (P＜0.05).Recurrent rates of T2 and T3 patients were 5.8%(8/138) and 14.0%(12/86), 5-year overall survival rates were 82.5% and 59.0%, 5-year disease-free survival rates were 70.4% and 52.2% respectively.These differences were all statistically significant (all P＜0.05). Conclusions T2N0 gastric cancer patients have a better prognosis than T3N0 patients. Depth of infiltration should be considered to stratify lymph node-negative gastric cancer patients for an adjunctive treatment and follow-up scheduling.