早期胃癌临床病理学特征与预后的关系

目的:探讨和总结早期胃癌的临床病理学特征及其与病人预后间的关系,分析早期胃癌的淋巴结转移规律,为微创治疗、缩小手术提供依据。方法:采用单因素及多因素的分析法,回顾分析2003年1月至2008年9月仁济医院普外科接受手术治疗的231例早期胃癌病人的临床及病理学资料。结果:单因素分析显示,肿瘤大小、浸润深度及淋巴结转移程度与早期胃癌的预后相关;多因素分析提示,淋巴结转移是早期胃癌预后的独立性危险因素。单发早期胃癌的淋巴结转移率为15.6%(36/231),黏膜内癌淋巴结转移率为5.7%(4/70),黏膜下癌淋巴结转移率为19.9%(32/161)。Logistic回归分析提示,肿瘤直径>2 cm(P=0.038,OR=1.351)和肿瘤浸润至黏膜下层(P=0.027,OR=3.635)是淋巴结转移的独立危险因子。本研究中,无淋巴结转移的早期胃癌病人,其术后3年生存率为98.6%,显著优于有淋巴结转移者(P2 cm、肿瘤浸润至黏膜下层是早期胃癌淋巴结转移的独立危险因子;术前应用影像学技术评估早期胃癌淋巴结转移情况有助于选择合理的治疗方案。     

伴远隔转移的早期胃癌临床病理特征

目的分析原发病灶局限于黏膜或黏膜下层,但同时伴有远隔转移早期胃癌的临床病理特征。方法回顾性分析1973年4月至1998年11月,中日两家大学8所附属医院的4420例(每家医院220~1270例)早期胃癌,其中22例伴有远隔转移。分析伴远隔转移的早期胃癌(远转组)和不伴远隔转移的早期胃癌(无转组)在性别、年龄、肿瘤大小、浸润深度、分化类型、长期存活率等方面的差异。结果远转组肿瘤与无转组在性别、肿瘤大小、浸润深度、5年存活率(远转组34.7%,无转组91.3%)方面差异有非常显著性意义(P<0.01);两组在年龄、分化程度方面差异无显著性意义。结论早期胃癌也可能发生远隔转移并导致预后不佳。女性、肿瘤浸润至黏膜下层且肿瘤直径>4cm可能是早期胃癌发生远隔转移的危险因素。     

早期胃癌淋巴结转移潜在危险因素分析

目的:探讨影响早期胃癌淋巴结转移的潜在危险因素,指导胃癌淋巴结清扫术(D1或D2)的合理应用。方法:回顾性分析1995年3月—2010年6月经手术治疗的336例早期胃癌患者的临床病理资料,对影响早期胃癌淋巴结转移的潜在危险因素进行单因素及多因素分析。结果:早期胃癌淋巴结转移与性别(P=0.010)、年龄(P=0.013)、肿瘤部位(P=0.042)、有无合并溃疡(P=0.001)、浸润深度(P<0.0001)、有无脉管癌栓(P<0.0001)有关,合并有溃疡(P=0.012)、浸润至黏膜下层(P=0.008)及有脉管癌栓(P=0.001)是淋巴结转移的独立性危险因素;黏膜内癌淋巴结转移与肿瘤部位(P=0.007)及大小(P=0.010)有关,肿瘤直径>20mm(P=0.041)是黏膜内癌淋巴结转移的独立性危险因素。结论:合并有溃疡、浸润至黏膜下层及有脉管癌栓的早期胃癌患者进行手术时,建议行淋巴结清扫(D2)术;肿瘤直径>20mm黏膜内癌也要考虑行淋巴结清扫(D2)术。     

早期胃癌淋巴结转移和临床病理特征的关系(附467例报道)

目的:探讨早期胃癌病人各临床病理因素与淋巴结转移的关系,为制定合理的治疗方案提供帮助.方法:对467例早期胃癌病人进行回顾性分析,对其年龄、性别、肿瘤大小、大体类型、分化程度、浸润深度、淋巴管癌栓与淋巴结转移的关系进行单因素和多因素分析.结果:影响早期胃癌淋巴结转移的因素主要有:肿瘤大小(最大径,≤2 cm比>2 cm,P<0.01)、分化程度(分化良好比分化不佳,P<0.01)、浸润深度(黏膜层比黏膜下层,P<0.01)、淋巴管癌栓(无比有,P<0.01).Logistic回归多因素分析结果显示,肿瘤大小、分化程度、浸润深度、淋巴管癌浸润均是提示胃癌是否有淋巴结转移的独立因素.结论:早期胃癌淋巴结转移与肿瘤大小、肿瘤分化程度、浸润深度、淋巴管癌栓等因素有关.确定早期胃癌手术方案时,可参考上述因素判断淋巴结转移风险,决定是否行淋巴结清扫术.     

早期胃癌淋巴结转移特征与危险因素

淋巴结转移是影响早期胃癌病人预后的独立危险因素。临床实践中准确诊断淋巴结转移对于病人的预后判断与治疗模式选择具有至关重要的作用。目前认为肿瘤浸润深度、脉管浸润、肿瘤组织分化类型、肿瘤病灶直径均与早期胃癌的淋巴结转移密切相关。对于具有淋巴结转移危险因素的早期胃癌病人,应慎重选择内镜下治疗方案,必要时选择追加外科手术对病人施行合理的淋巴结清扫。     

早期胃癌淋巴结转移的相关危险因素分析

目的探讨早期胃癌淋巴结转移的相关危险因素,为合理制定治疗方案提供参考依据。方法对安徽省肿瘤医院胃肠肿瘤外科于2013年2月至2017年11月期间行胃癌根治术的148例早期胃癌患者的临床病理资料进行回顾性研究,对早期胃癌患者的年龄、性别、肿瘤大小、肿瘤部位、大体类型、组织学类型、浸润深度及是否有脉管神经侵犯与淋巴结转移的关系进行单因素及多因素分析。结果本组148例早期胃癌患者中有15例发生淋巴结转移,淋巴结转移发生率为10.14%,其中黏膜内癌的淋巴结转移率为1.43%(1/70),黏膜下层癌的淋巴结转移率为17.95%(14/78)。单因素分析结果显示,早期胃癌患者的年龄、肿瘤大体类型、肿瘤大小、浸润深度及有脉管神经侵犯情况与其淋巴结转移有关(P0.050);多因素logistic回归分析结果显示,肿瘤浸润深度和有脉管神经侵犯是早期胃癌发生淋巴结转移的独立危险因素(P0.050)。结论肿瘤浸润深度及有脉管神经侵犯与早期胃癌淋巴结转移密切相关,术前正确评估淋巴结转移情况对早期胃癌患者的治疗方式选择及判断患者的预后至关重要。     

早期胃癌淋巴结转移的多因素分析

目的探讨早期胃癌淋巴结转移的相关因素,为早期胃癌患者治疗方案的选择提供参考。方法回顾性分析2010年1月~2016年12月186例早期胃癌在我院行胃癌根治术的临床病理资料,包括性别、年龄、肿瘤大小、肿瘤部位、有无溃疡、大体分型、组织学分型、浸润深度、肿瘤数量等。采用二元logistic回归模型分析早期胃癌淋巴结转移与临床病理特征的关系,采用logistic回归模型进行多因素分析,联合上述独立影响因素分层分析早期胃癌淋巴结转移情况。结果 186例早期胃癌的淋巴结转移率为11.8%(22/186)。单因素分析显示浸润深度(P=0.020)、组织学分型(P=0.013)、有无溃疡(P=0.013)与早期胃癌淋巴结转移显著相关。多因素logistic回归分析表明浸润至黏膜下层(OR=3.370,95%CI:1.191~9.537,P=0.022)、未分化型(OR=3.325,95%CI:1.187~9.313,P=0.022)以及合并溃疡(OR=5.202,95%CI:1.144~23.662,P=0.033)是早期胃癌发生淋巴结转移的独立影响因素,其中溃疡是作用最强的影响因素。联合上3个独立影响因素分层分析显示,分化型且不合并溃疡的早期胃癌,无论浸润深度和肿瘤大小,均未见淋巴结转移(0/41),未分化型且不合并溃疡者中仅2例出现淋巴结转移,其余各组合并溃疡的早期胃癌均有淋巴结转移。结论早期胃癌浸润至黏膜下层、未分化型以及合并溃疡均易发生淋巴结转移,其中合并溃疡时发生淋巴结转移的风险最大;分化型且不合并溃疡的早期胃癌淋巴结转移风险较低,可考虑行内镜下治疗,但术后需要密切随访。     

肿瘤大小与早期胃癌预后的关系

目的 探讨早期胃癌的预后因素,特别是肿瘤大小与早期胃癌预后的关系.方法 回顾性分析1998年1月至2002年2月119例在中国医学科学院肿瘤医院外科治疗的早期胃癌的临床病理特征,分析早期胃癌的预后因素.结果 本组早期胃癌病例5年生存率为90.9%,其预后主要与肿瘤大小相关,直径＜2 cm组、2 cm≤直径＜4 cm组与直径≥4 cm组5年生存率分别为100%、92.0%、80.8%,差异有统计学意义,P=0.024.同时比较淋巴结转移及浸润深度等因素,P值分别为0.816及0.371,差异无统计学意义.肿瘤大小与其他预后因素之间无明显相关性.结论 早期胃癌浸润深度及淋巴结转移与其预后关系不明确,而肿瘤大小很可能是早期胃癌独立的预后因素,对指导早期胃癌预后及手术选择有实用价值.     

肿瘤大小对T3期胃癌患者预后的影响

目的探讨肿瘤大小对T3期胃癌患者预后的影响。方法对408例L期胃癌患者施行胃癌D2根治术,应用Cox比例风险模型对肿瘤大小进行最佳截点的筛选。对全组T3期胃癌患者的预后因素进行单因素及多因素分析：并对大直径组及小直径组胃癌患者的预后因素进行多因素分析。结果本组408例T3期胃癌患者通过Cox比例风险模型筛选出肿瘤大小的最佳截点为8cm。肿瘤大于或等于8cm的胃癌患者（大直径组）85例．小于8cm的胃癌患者（小直径组）323例：大直径组和小直径组术后5年生存率分别为33．8％和52．2％,差异有统计学意义（P〈0．05）。通过Cox比例风险模型分析显示,肿瘤大小、淋巴结转移、Boi Tmann分型和肿瘤部位是影响全组患者预后的独立因素（均P〈0．01）：进一步按肿瘤大小进行分层预后分析显示,Borrmann分型和淋巴结转移是影响大直径组患者预后的独立因素（均P〈0．05）;淋巴结转移是影响小直径组患者预后的独立因素（P〈0．01）。结论以8cm为界值进行B期胃癌患者的预后判断准确性最高。肿瘤大小是影响B期胃癌患者预后的独立因素。     

早期胃癌淋巴结转移规律与腹腔镜手术方式的探讨

目的:探讨不同组织学类型早期胃癌的淋巴结转移情况,为腹腔镜胃癌缩小手术提供理论依据。方法:回顾分析2004年1月至2012年12月收治的696例早期胃癌患者,对比不同组织学类型早期胃癌的临床病理特征,并对其与淋巴结转移的相关性进行单因素及多因素分析。结果:与其他类型腺癌相比,早期印戒细胞癌更常见于女性,肿瘤部位常见于胃体中部,印戒细胞癌患者通常是小于50岁的患者(P0.001),隆起型、混合型少见(P0.001),差异有统计学意义,在黏膜下入侵的发生率、淋巴管肿瘤浸润、淋巴结转移方面,印戒细胞癌与高分化腺癌相似,但与中、低分化腺癌差异有统计学意义(P0.001)。中、低分化腺癌,肿瘤直径≥20 mm,黏膜下入侵,淋巴管肿瘤浸润,为淋巴结转移的独立危险因素。肿瘤直径20 mm,且无淋巴管肿瘤浸润的黏膜内印戒细胞癌无淋巴结转移,肿瘤直径≥20 mm,且无淋巴管肿瘤浸润的黏膜内印戒细胞癌表现出较低的淋巴结转移率。结论:印戒细胞型早期胃癌的淋巴结转移率及黏膜下入侵率与高分化腺癌相似,无淋巴管肿瘤浸润的印戒细胞型黏膜内胃癌患者可行腹腔镜缩小手术。     

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??Postoperative complications and the risk factors of radical gastrectomy for gastric cancer ZHENG Chao-Hui, LU Jun??HUANG Chang-Ming, et al. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail: hcmlr2002@163.com
Abstract Objective To investigate the associated risk factors of postoperative complications in gastric cancer after radical gastrectomy. Methods The clinical data of 1876 patients with gastric cancer performed radical gastrectomy from January 2007 to June 2012 were analyzed retrospectively. The risk factors determined postoperative complications were investigated by univariate and multivariate analysis. Results The postoperative complications occurred in 291 (15.5%) of 1876 patients. According to univariate analysis, tumor size, preoperative comorbidity, depth of invasion, lymph node metastasis, operation time,surgeon’s experience and laparoscopic surgery were related to postoperative complications??P<0.05??. By logistic regression analysis??it was revealed that there were six significant factors for postoperative complications such as tumor size, preoperative comorbidity, lymph node metastasis, operation time,surgeon’s experience and laparoscopic surgery. The first flatus time and postoperative hospital stay in patients with postoperative complications were significantly longer than those in patients without postoperative complications ??P<0.05??. The incidence of postoperative surgical complications of laparoscopic group and open group had no significant difference. However, postoperative non-surgical complication rate of laparoscopic group is lower significantly (P<0.05). Conclusion Tumor size, preoperative comorbidity, lymph node metastasis, operation time, surgeon’s experience and laparoscopic surgery were the main risk factors of postoperative complications in laparoscopy-assisted radical gastrectomy. Laparoscopic surgery can significantly reduce the incidence of postoperative non-surgical complications     

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??Prevention and treatment of bleeding for laparoscopic spleen-preserving splenic hilus lymphadenectomy for gastric cancer HUANG Chang-ming??CHEN Qi-yue. Department of Gastric Surgery??Fujian Medical University Union Hospital??Fuzhou 350001??China
Corresponding author??HUANG Chang-ming??E-mail??hcmlr2002@163.com
Abstract Splenic hilar lymph node (LN) should be removed in a D2 lymph node dissection for the advanced proximal gastric cancer??according to Japanese Gastric Cancer Treatment Guidelines 2010. In recent years??with the continuous development and improvement of laparoscopic anatomy technology and equipment??and the in-depth study of spleen function??laparoscopic spleen-preserving splenic hilus lymphadenectomy has received more and more attention and been gradually being used in operations. However??because of the complexity of splenic hilar anatomy??the challenges of metastatic lymph node dissection??obesity??adhesions of the splenic hilus??etc. bleeding is often a challenge for surgeons in laparoscopic spleen-preserving splenic hilus lymphadenectomy. Therefore??mastering the strategies of prevention and treatment of bleeding for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation.     

Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience

Background

The prognosis of early gastric cancer (EGC) with signet ring cell histology is more favorable than other undifferentiated gastric adenocarcinomas. An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of EGC with signet ring cell histology. Therefore, this study analyzed the predictive factors associated with lymph node metastasis in patients with this type of EGC.

Methods

A total of 136 EGC with signet ring cell histology patients who underwent D2 radical gastrectomy were reviewed in this study. The clinicopathologic features were analyzed to identify predictive factors for lymph node metastasis.

Results

The overall rate of lymph node metastasis in EGC with signet ring cell histology was 10.3%. Using a univariate analysis, the risk factors for lymph node metastasis were identified as the tumor size, depth of tumor invasion, and lymphovascular invasion. The multivariate analysis revealed that tumor size >2 cm, submucosal invasion, and lymphovascular invasion were independent risk factors of lymph node metastasis (P < 0.05).

Conclusions

The risk of lymph node metastasis of EGC with signet ring cell histology was high in those with tumor sizes ≥2 cm, submucosal tumors, and lymphovascular invasion. A minimally invasive treatment, such as endoscopic resection, might be possible in highly selective cases of EGC with signet ring cell histology with intramucosal invasion, tumor size <2 cm, and no lymphovascular invasion.     

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??Clinicopathological Characteristics Associated with Lymph Node Metastasis in Early Gastric Cancer with Submucosal Invasion SHEN Li-zong, HUANG Yi-ming, SUN Mao-cai, et al. Department of General Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China Corresponind author: SHEN Li-zong, E-mail: shenlz@163.com Abstract Objective To investigate the clinicopathological characteristics of early gastric cancer with submucoal invasion associated with lymph node metastasis. Methods The data from 181 patients surgically treated for early gastric cancer with submucosal invasion between 1998 and 2007 were reviewed retrospectively. The clinicopathological variables associated with lymph node metastasis were evaluated. Results Lymph node metastasis was observed in 20.44% of patients. The histological classification, tumor size, location in the stomach and presence of vascular or lymphatic invasion showed a positive correlation with the rate of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification and tumor size to be significantly and independently related to lymph node metastasis. Conclusion Histological classification, tumor size, location in the stomach and presence of vascular or lymphatic invasion are risk factors for lymph node metastasis in early gastric cancer with submucoal invasion. Minimal invasive treatment, such as endoscopic submucosal dissection, may be possible in highly selective cancers.     

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??Standardization and technical tips in totally laparoscopic gastrectomy for gastric cancer HUANG Chang-ming??LIN Jian-xian. Department of Gastric Surgery??Fujian Medical University Union Hospital??Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail??hcmlr2002@163.com
Abstract The application of laparoscopic gastrectomy for gastric cancer has more than 20 years. With the development of technology and equipment??on the basis of the guarantee a radical cure and effect of minimally invasive surgery??to improve the quality of patient's life??more and more centers have carried out the laparoscopic radical gastrectomy for gastric cancer. The standardization of totally laparoscopic radical gastrectomy is according to the open surgery. For a completely lymph node dissection??surgeons need be familiar with the normal anatomy and variation of the blood vessels around the stomach??select the appropriate surgical approach??perform the operation step by step and with the help of team cooperation. At the same time??it is very important of postoperative digestive tract reconstruction. It needs to choose the right cases and method to carry out the totally laparoscopic digestive tract reconstruction??in order to make an better advantage of minimally invasive surgery for gastric cancer.     

Risk Factors for Lymph Node Metastasis in Undifferentiated Early Gastric Cancer

Background Endoscopic surgery has not been accepted as a curative treatment for intramucosal undifferentiated early gastric cancer (EGC). The purpose of this study was to evaluate the predictive factors of lymph node metastasis and explore the possibility of using endoscopic surgery for undifferentiated EGC. Methods We retrospectively analyzed 646 patients with undifferentiated EGC who had undergone gastrectomy with D2 lymphadenectomy from January 2000 to March 2005. We used univariate and multivariate analysis to identify clinicopathological features that were predictive factors for lymph node metastasis. Results The incidence of lymph node metastasis was 4.2% in intramucosal and 15.9% in submucosal undifferentiated EGC. Multivariate analysis revealed that submucosal invasion, larger tumor size (greater than 2 cm), and presence of lymphovascular invasion (LVI), were significantly associated with lymph node metastasis in patients with undifferentiated EGC. Tumor size and LVI were independent risk factors for lymph node metastasis in cases of intramucosal EGC. Lymph node metastasis was found in only one patient (0.5%) who had neither of the two risk factors for intramucosal EGC. Conclusion Complete endoscopic resection may be acceptable as a curative treatment for intramucosal undifferentiated EGC when the tumor size is less than or equal to 2 cm, and when LVI is absent in the postoperative histological examination. Radical gastrectomy should be recommended if LVI or unexpected submucosal invasion is present.     

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??Study on clinicopathological features and prognostic factors in Borrmann type I gastric cancer HUANG Bao-jun, XU Hui-mian. Department of Surgical Oncology, First Hospital of China Medical University, Shenyang 110001, China
Corresponding author: XU Hui-mian, E-mail: xuhuimian@126.com.
Abstract Objective To study the clinicopathological features and prognostic factors in Borrmann type I gastric cancer. Methods A retrospective analysis of gastric cancer database from 1980 to 2006, at the Department of Surgical Oncology, First Affiliated Hospital, China Medical University was performed. A total of 110 patients with Borrmann type I were selected, followed up and analyzed. Results Among all the patients, 89 patients were male, 21 patients were female. 63 with tumor size more than 6.0 cm, 68 with massive or nested growth pattern. A total of 62 patients were with positive lymph node metastasis. According to 7th UICC/TNM stage, there were 21 patients in N1, 22 patients in N2, and 19 patients in N3. Twenty-three patients were in level I, 34 in level II, and 5 in leveal III/M based on JGC/N stage. Gender and lymphatic/venous invasion were independent factors on lymph node metastasis by uni- and multivariate analysis. Gender, depth of tumor invasion, radical degree and JGC node classification were the independent prognostic factors??P??0.05??. Conclusion There are relatively independent clinicopathological features in Borrmann type I gastric cancer. The more lymph node metastasis and poorer prognosis are observed in female patients.     

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??Perioperative complication incidence between laparoscopic and open radical resection for advanced gastric cancer: A case control study LI Ping, HUANG Chang-ming, ZHENG Chao-hui,et a1. Department of Gastric Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail: hcmlr2002@163.com
Abstract Objective To compare the surgical complication incidence between laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) for advanced gastric cancer (AGC) and the related risk factors of postoperative complications after radical gastrectomy. Methods A retrospective case-control study was performed comparing LAG and OG for AGC.A total of 148 patients with AGC underwent LAG between January 2010 and December 2011 in Affiliated Union Hospital of Fujian Medical University were enrolled and were compared with 148 AGC patients underwent OG during the same period. The perioperative complication morbidity and mortality were compared between the two groups. The risk factors determined postoperative complications were investigated by univariate and multivariate analysis. Results The intraoperative complication incidence was 4.1% in LAG group and 4.7% in OG group??P??0.05??.The postoperative complication incidence was 10.8% in LAG group and 20.9% in OG group??P??0.05??, among which the complication incidence of postoperative intestinal obstruction was 1.4% and 6.1% in LAG group and in OG group??P??0.05??,and the complication incidence of postoperative pulmonary infection was 3.4% and 9.5% in LAG group and in OG group??P??0.05??.There was no significant difference between the two groups in other postoperative complication incidence??P??0.05??. According to univariate analysis, depth of invasion, lymph node metastasis, operation time and laparoscopic surgery were related to postoperative complications??P??0.05??. Multivariate logistic regression analysis showed that whether laparoscopic surgery and operation time were independent risk factors for postoperative complications??P??0.05??. Conclusion There is no difference in intraoperative complication incidence between LAG and OG groups. But the postoperative complication incidence is significantly lower in LAG group than that in OG group. Whether laparoscopic surgery is an independent risk factor for postoperative complications in advanced gastric cancer.     

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??Clinicopathologic analysis on recurrence and metastasis in early gastric cancer after radical resection??A report of 629 patients HUANG Bao-jun, SUN Zhe, WANG Zhen-ning, et al. Department of Gastrointestinal Oncological Surgery, the First Hospital of China Medical University, Shenyang 110001, China
Corresponding author??XU Hui-mian, E-mail: xuhuimian@126.com
Abstract Objective To evaluate the recurrence rate, patterns and influenced factors on early gastric cancer (EGC) after radical resection. Methods The clinical data of 629 patients with EGC underwent gastrectomy, lymphadenectomy and follow-up between January 1980 and September 2012 in Department of Surgical Oncology, the First Hospital of China Medical University were analyzed retrospectively. The recurrent rate, type, survival rate and influenced factors were evaluated by univariate and multivariate analysis. Results A total of 31 patients (4.9%) had recurrence during the follow-up. Hematogenous metastasis such as liver, lung, brain and bone represented the predominant pattern of relapse, accounting for over half (54.8%), and most of which occurred within five years after surgery. The other recurrence patterns were lymph node metastasis, peritoneal dissemination and remnant gastric cancer. The 5-year, 10-year, 15-year, 20-year and 25-year tumor free survival rate and overall survival rate for EGC was 94.0% and 81.0%, 91.0% and 64.0%, 89.0% and 52.0%, 89.0% and 47.0%, 89.0% and 33.0%, respectively. The multivariate analysis showed that patients with lymphovascular invasion and N2 lymph node metastasis according to Japanese Criteria of Gastric Cancer (JCGC) had the higher risk of recurrence and metastases than patients in the control group. Conclusion Hematogenous recurrence is the major mode of relapse and most of which occur within five years after surgery in EGC. The patients with positive lymphovascular invasion and N2 lymph node metastasis according to JCGC are apt to relapse.     

胃黏膜下层癌淋巴结转移临床病理因素分析

【摘要】 目的 研究胃黏膜下层癌淋巴结转移率及其影响因素。 方法 回顾性分析南京医科大学第一附属医院1998年1月至2007年12月手术证实的181例胃黏膜下层癌的临床病理资料,对病人年龄、性别、肿瘤组织学类型、形态学类型、大小、部位、浸润深度、脉管内癌栓等与淋巴结转移的关系进行单因素与多因素分析。 结果 胃黏膜下层癌淋巴结转移率为20.44%。影响胃黏膜下层癌淋巴结转移的因素主要有肿瘤组织学类型（分化型 vs 分化不良型,P =0.0352）、直径大小（＜2cm vs ≥2cm,P =0.0143）、部位（近端胃vs胃体vs远端胃,P =0.0254）及脉管内癌栓（无vs有,P =0.0323）。Logistic回归分析显示肿瘤组织学类型与大小为胃黏膜下层癌淋巴结转移的独立性危险因素。结论 胃黏膜下层癌淋巴结转移与肿瘤组织学类型、大小、部位及脉管内癌栓等因素有关。临床上应参考上述临床病理因素判断淋巴结转移风险,制定合适的治疗方案。