早期胃癌淋巴结转移的特点及危险因素分析

目的 探讨早期胃癌淋巴结转移的临床特点及其发生的危险因素。方法 对2014年1月至2018年12月在江苏省人民医院经病理诊断为早期胃癌并接受胃切除术和淋巴结清扫的892例患者临床资料进行回顾性分析。根据有无发生淋巴结转移,将早期胃癌患者分为两组(无淋巴结转移组、淋巴结转移组),比较两组患者的基本资料、病灶内镜下特征及病理学特征,采用Logistic回归分析早期胃癌淋巴结转移的危险因素。结果 9 004例胃癌患者中,早期胃癌患者为892例(9.9%),淋巴结转移率为11.2%。早期胃癌淋巴结转移与年龄、性别、肿瘤部位、肿瘤大小、大体类型、浸润深度、分化类型、组织学形态、脉管浸润和TNM分期相关;多因素分析结果显示,黏液腺癌(OR=3.265,95%CI:1.258～8.470,P=0.049),发生脉管浸润(OR=12.213,95%CI:4.454～33.489,P<0.001)是早期胃癌淋巴结转移独立危险因素。结论 黏液腺癌和出现脉管浸润的早期胃癌患者可能具有更高的淋巴结转移风险,建议对出现以上危险因素的早期胃癌患者进行全面评估以决定治疗方案。     

影响早期胃癌淋巴结转移的因素分析

目的：探讨早期胃癌淋巴结转移的规律，为具有不同临床病理特征的早期胃癌设计合理的治疗方案。方法：应用ＳＰＳＳ＋软件对早期胃癌患者的临床病理因素与淋巴结转移的关系行多因素分析。结果：影响淋巴结转移的独立性危险因素有：淋巴管癌浸润、肿瘤直径大于２ｃｍ及癌浸润到粘膜下层。结论：对于肿瘤直径小于２ｃｍ、无淋巴管癌浸润的粘膜癌可行内窥镜治疗，其它的粘膜癌行Ｄ１＋第７组淋巴结清除术，粘膜下层癌行Ｄ２根治术。     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要.运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量.     

早期胃癌淋巴结转移及临床意义

淋巴结转移是影响早期胃癌手术方式选择和预后的重要因素,对其转移规律和特点的认识及检测方法的掌握对于合理开展缩小手术至关重要。运用免疫组化和逆转录聚合酶链反应技术对早期胃癌前哨淋巴结检测不仅可以了解淋巴结站的转移特点、规律,而且可以发现微转移,从而指导术中淋巴结清扫范围而选择合理术式,避免标准根治术淋巴结清扫和扩大的手术方式对机体造成不必要的损害,减少手术创伤和术后并发症的出现,提高患者术后生存质量。     

影响早期胃癌预后及淋巴结转移因素分析

[目的]分析影响早期胃癌生存期的因素并探讨年龄、性别及临床病理特点对早期胃癌淋巴结转移的影响。[方法]收集1979年7月至2004年8月在福建医科大学附属协和医院肿瘤内科治疗的161例早期胃癌患者的临床资料,并应用BinaryLogistic回归、寿命表法和Cox回归等方法进行统计学分析。[结果]单因素分析影响生存期的因素有:浸润深度、淋巴结转移、淋巴管瘤栓、静脉瘤栓、病灶数目、肿瘤大小、淋巴结清扫范围;多因素分析独立影响因素有:淋巴结转移。淋巴结转移率14.9%(24/161),单因素分析影响淋巴结转移的因素有:浸润深度、淋巴管瘤栓、肿瘤大小和病理类型;多因素分析独立影响因素有:浸润深度和病理类型。[结论]对侵及黏膜下层、未分化型、术前或术中检测淋巴结转移阳性的早期胃癌应尽可能扩大手术范围(D2淋巴结清扫术),以提高早期胃癌的长期生存率。     

458例胃癌患者的淋巴结转移模型预测及危险因素分析

目的 探讨胃癌患者与淋巴结转移相关的危险因素,并尝试建立预测模型,用来评价淋巴结转移的风险.方法 选择2014年1月至2019年12月郑州大学第一附属医院收治并经病理证实的458例早期胃癌术后患者的临床病理资料,所有患者均行根治性胃癌根治术+淋巴结清扫术.利用单因素及多因素分析筛选胃癌淋巴结转移的危险因素,并依此建立预...     

未分化型早期胃癌淋巴结转移的影响因素分析

摘 要：［目的］ 研究未分化型早期胃癌临床病理特征、血清肿瘤标志物与胃癌淋巴结转移的相关性。［方法］ 选择接受胃癌根治术并经术后病理诊断为未分化型早期胃癌患者80例,分析内镜特征、临床病理特征、术前血清肿瘤标志物与胃癌淋巴结转移的相关性。［结果］ 80例患者中,18例有淋巴结转移。有淋巴结转移组患者黏膜下癌比例、有脉管浸润比例、血清G-17含量均明显高于无淋巴结转移组患者,血清PG-Ⅱ/PG-Ⅰ比值明显低于无淋巴结转移组患者,差异均有统计学意义（P均<0.05）。Logistics回归分析显示,黏膜下癌（OR=1.944,95%CI：1.452～2.853）、脉管浸润（OR=1.775,95%CI：1.378～2.512）、术前血清G-17升高（OR=1.661,95%CI：1.277～2.451）及PG-Ⅱ/PG-Ⅰ比值降低（OR=2.039,95%CI：1.503～2.849）是未分化型早期胃癌淋巴结转移的独立危险因素。［结论］ 黏膜下癌、脉管浸润、术前血清G-17升高及PG-Ⅱ/PG-Ⅰ比值降低可能增加未分化型早期胃癌淋巴结转移的风险。     

早期胃癌的浸润深度与淋巴结转移关系

目的：探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性。方法：收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点。结果：103例早期胃癌中黏膜内癌（M）31例,仅有1例（3％）淋巴结转移,黏膜下癌（SM）有63例,淋巴结转移率为17％,其中SM1：16．1％,SM2：34％,SM3：35％;肿瘤最大直径超过2cn的淋巴结转移率（20％）较直径≤2cm者（8．8％）高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高。结论：早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关。     

早期胃癌的浸润深度与淋巴结转移关系

目的:探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性.方法:收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点.结果:103例早期胃癌中黏膜内癌(M)31例,仅有1例(3%)淋巴结转移,黏膜下癌(SM)有63例,淋巴结转移率为17%,其中SM1:16.1%,SM2:34%,SM3:35%;肿瘤最大直径超过2cm的淋巴结转移率(20%)较直径≤2cm者(8.8%)高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高.结论:早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关.     

cN0甲状腺乳头状癌淋巴结转移的危险因素分析

背景与目的：术后病理证实的淋巴结转移在临床淋巴结转移阴性(clinical lymph node negative, cN0)的甲状腺乳头状癌中并不罕见,该研究旨在探讨cN0甲状腺乳头状癌淋巴结转移的危险因素,特别是大量淋巴结转移(>5个)、单侧单发癌灶对侧中央区转移的危险因素。方法：收集北京协和医院2008年—2014年由同一手术团队实施手术的cN0甲状腺乳头状癌患者350例(男性85例,女性265例;其中单侧单发癌灶212例)。分析患者的临床病理学特征,通过单因素、多因素分析寻找淋巴结转移的危险因素。结果：350例患者中共出现淋巴结转移138例(39.4%),大量淋巴结转移20例(5.7%),在单侧单发癌灶且行双侧腺体切除联合双侧中央区淋巴结清扫的169例患者中,24例出现对侧中央区淋巴结转移(14.2%)。淋巴结转移的危险因素的单因素分析中,肿物大小小于等于1 cm和大于1 cm(33.6%vs 58.5%,P<0.01)、超声肿物有钙化和无钙化者(31.7%vs 43.7%, P=0.03)淋巴结转移差异有统计学意义;多因素分析中,非微小癌是淋巴结转移的独立危险因素(OR=2.792, P<0.001)。出现大量淋巴结转移危险因素的单因素分析中,女性和男性(3.8%vs 11.8%,P=0.012)、年龄小于40岁和大于等于40岁(10.7%vs 3.4%,P=0.006)、肿物大小小于等于1 cm和大于1 cm(3.4%vs 13.4%,P=0.002)、超声肿物低回声和非低回声(13.9%vs 4.8%,P=0.026)者在有无大量淋巴结转移上差异有统计学意义;多因素分析中,男性(OR=5.152,P=0.002)、非微小癌(OR=5.712,P=0.001)、年龄小于40岁(OR=3.959,P=0.006)是大量淋巴结转移的独立危险因素。男性(OR=3.105,P=0.022)、非微小癌(OR=3.863,P=0.008)是单侧单发癌灶对侧中央区淋巴结转移的独立危险因素,其对侧中央区淋巴结转移率分别为26.5%、26.1%。结论：cN0甲状腺乳头状癌出现淋巴结转移的比例较高;对于其中非微小甲状腺乳头状癌应常规行中央区淋巴结清扫,对于男性、年龄小于40岁的微小甲状腺乳头状癌也应考虑采取积极的手术方式。     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

Nomogram established using risk factors of early gastric cancer for predicting the lymph node metastasis

BACKGROUND For the prognosis of patients with early gastric cancer(EGC), lymph node metastasis(LNM) plays a crucial role. A thorough and precise evaluation of the patient for LNM is now required.AIM To determine the factors influencing LNM and to construct a prediction model of LNM for EGC patients.METHODS Clinical information and pathology data of 2217 EGC patients downloaded from the Surveillance, Epidemiology, and End Results database were collected and analyzed. Based on a 7:3 ratio, 1550 pe...     

Using nomogram,decision tree,and deep learning models to predict lymph node metastasis in patients with early gastric cancer: a multi-cohort study

The accurate assessment of lymph node metastasis (LNM) in patients with early gastric cancer is critical to the selection of the most appropriate surgical treatment. This study aims to develop an optimal LNM prediction model using different methods, including nomogram, Decision Tree, Naive Bayes, and deep learning methods. In this study, we included two independent datasets: the gastrectomy set (n=3158) and the endoscopic submucosal dissection (ESD) set (n=323). The nomogram, Decision Tree, Naive Bayes, and fully convolutional neural networks (FCNN) models were established based on logistic regression analysis of the development set. The predictive power of the LNM prediction models was revealed by time-dependent receiver operating characteristic (ROC) curves and calibration plots. We then used the ESD set as an external cohort to evaluate the models’ performance. In the gastrectomy set, multivariate analysis showed that gender (P=0.008), year when diagnosed (2006-2010 year, P=0.265; 2011-2015 year, P=0.001; and 2016-2020 year, P<0.001, respectively), tumor size (2-4 cm, P=0.001; and ≥4 cm, P<0.001, respectively), tumor grade (poorly-moderately, P=0.016; moderately, P<0.001; well-moderately, P<0.001; and well, P<0.001, respectively), vascular invasion (P<0.001), and pT stage (P<0.001) were independent risk factors for LNM in early gastric cancer. The area under the curve (AUC) for the validation set using the nomogram, Decision Tree, Naive Bayes, and FCNN models were 0.78, 0.76, 0.77, and 0.79, respectively. In conclusion, our multi-cohort study systematically investigated different LNM prediction methods for patients with early gastric cancer. These models were validated and shown to be reliable with AUC>0.76 for all. Specifically, the FCNN model showed the most accurate prediction of LNM risks in early gastric cancer patients with AUC=0.79. Based on the FCNN model, patients with LNM rates of >4.77% are strong candidates for gastrectomy rather than ESD surgery.     

Risk factors for para-aortic lymph node metastasis of gastric cancer from a randomized controlled trial of JCOG9501

BACKGROUND: No risk factor has been confirmed for para-aortic lymph node (PAN) metastasis from gastric cancer. To identify the risk factors and the most frequent route of metastasis to PAN, we analyzed the prospective data from a phase III trial. METHODS: In JCOG9501 comparing D2 and D2 + PAN dissection, 260 patients with T2(SS)-T4 gastric cancer underwent radical gastrectomy with PAN dissection. The association between various clinicopathological factors and PAN metastasis was examined. RESULTS: Macroscopic N stage and tumor size > or = 5 cm were significant risk factors for PAN metastasis after adjusting for other factors. The proportion of PAN metastasis was clearly different between the N0-1 group and the N2-4 group (2.8% versus 20.5%). In the additional multivariate analysis including 17 regional lymph node stations, station No. 7 was the only station with statistical significance (P = 0.002, odds ratio = 41.0). CONCLUSION: Macroscopic N stage and tumor size were associated with PAN metastasis, and the lymphatics along the left gastric artery seemed to be the most frequent route to the nodes surrounding the aorta. These findings may be useful in predicting PAN metastasis.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

胃癌淋巴结转移相关分子标志物的研究进展

复发和转移是导致胃癌死亡率高居不下的主要原因,淋巴结转移是胃癌转移的一个早期事件和独立的预后因素。胃癌淋巴结转移过程可能涉及到许多分子作用机制和信号传导途径,包括肿瘤淋巴管生成相关基因、细胞粘附分子、细胞外基质相关蛋白、细胞因子、肿瘤转移相关基因等。本文综述胃癌淋巴结转移的相关分子标志物的研究进展。