胃癌淋巴结转移相关危险因素及其临床预测价值分析

背景与目的:淋巴结转移与胃癌患者预后之间密切关联,且淋巴结转移与否及淋巴结转移程度对患者治疗方案的选择至关重要,但目前术前淋巴结转移预测方法仍有一定局限性。本研究旨在探讨胃癌患者淋巴结转移现象的相关危险因素,为术前预测淋巴结转移提供一定途径。方法:回顾2014年1月-2015年4月收治的380例胃癌患者的临床与随访资料,分析淋巴结转移与患者相关临床病理因素的关系,从中寻找出胃癌淋巴结转移危险因素,并进一步用ROC曲线分析危险因素对胃癌淋巴结转移的预测能力,用Kaplan-Meier法分析危险因素对患者预后的影响。结果:380例患者中,241例(63.42%)发生淋巴结转移。单因素分析结果显示,BMI、肿瘤浸润深度、分化程度、Lauren’s分型、肿瘤直径以及肿瘤标志物CA125与胃癌淋巴结转移明显有关(均P<0.05);多因素分析结果显示,BMI(OR=4.175,P=0.041)和肿瘤浸润深度(OR=16.444,P<0.000 1)是胃癌淋巴结转移的独立危险因素;相关性分析结果显示,淋巴结转移阳性率与BMI值呈明显正相关(r=1.95,P=0.007)。BMI(以24 kg/m^2为临界值)与肿瘤浸润深度分级(以T4期为标准)预测是否有淋巴结转移的敏感度均为63.16%,特异度分别为76.84%、53.68%;两者联合应用特异度增高至88.36%,ROC曲线下面积达75.76%。生存分析结果显示,高BMI值患者的3年总生存率明显低于低BMI值患者(51.09% vs.53.13%,P<0.05)。结论:BMI与肿瘤浸润深度是胃癌患者淋巴结转移的独立危险因素,患者BMI值越高淋巴结转移的可能性越大,结合肿瘤浸润深度情况分析,对术前预测淋巴结转移有一定的临床实用价值。

Analysis of risk factors associated with lymph node metastasis in gastric cancer and their clinical predictive value

Background and Aims:There is a close relationship between lymph node metastasis and the prognosis of the gastric cancer patients,and the presence or absence,as well as the degree of lymph node metastasis are crucial for treatment decision making of the patients.However,there are still many challenges in preoperative evaluation of the lymph node metastasis.The purpose of this study is to investigate the relevant risk factors for lymph node metastasis in gastric cancer patients,so as to provide certain way criteria for predicting lymph node metastasis before operation.Methods:The clinical and follow-up data of 380 patients with gastric cancer treated during January 2014 to April 2015 were reviewed.The relationship between lymph node metastasis and the relevant clinicopathologic factors of the patients were analyzed,in which,the risk factors for lymph node metastasis of gastric cancer were determined.Further,the efficiencies of the risk factors for predicting lymph node metastasis in gastric cancer were assessed by ROC curve,and the impacts of the risk factors on the prognosis of the patients were analyzed by Kaplan-Meier method.Results:Of the 380 patients,lymph node metastasis occurred in 241 cases (63.42%).The results of univariate analysis showed that BMI,depth of tumor invasion,degree of differentiation,Lauren’s classification,tumor diameter and tumor marker CA125 were significantly associated with the metastasis of lymph node in gastric cancer (all P<0.05);the results of multivariate analysis revealed that BMI (OR=4.175,P=0.041) and the depth of tumor invasion (OR=16.444,P<0.000 1) were independent risks for lymph node metastasis;the results of correlation analysis demonstrated that there was a significant positive correlation between the positive rate of lymph node metastasis and BMI value (r=1.95,P=0.007).BMI (using 24 kg/m^2 as a cut-off value) and depth of tumor invasion (using T4 stage as a threshold) had a same sensitivity of 63.16% and a specificity of 76.84% and 53.68% respectively for predicting the presence or absence of lymph node metastasis in gastric cancer;the specificity of their combined use was increased to 88.36%,and the area under the ROC curve reached 75.76%.The results survival analysis showed that the 3-year overall survival rate in patients with high BMI value was significantly lower than that in patients with low BMI value (51.09% vs.53.13%,P<0.05).Conclusion:BMI and depth of tumor invasion are independent risk factors for lymph node metastasis in gastric cancer.Patients with high BMI value may face an increased risk of lymph node metastasis in gastric cancer.The combined consideration of BMI and depth of tumor invasion may have certain practical value in predicting lymph node metastasis before operation.