pN3胃癌的预后分析

目的 本研究通过对pN3胃癌术后患者的生存分析来进一步评估此组患者的预后差异.方法 回顾性分析1980年1月～2005年12月的胃癌手术患者中成功行R0、D2＋且术后经病理证实为胃腺癌,按第七版UICC选取淋巴结转移数目大于6个即pN3,且临床病理学资料、随访资料齐全的病例394例,临床病理因素作为影响预后的因素进行单因素及多因素分析.结果 总的5年生存率为29%,单因素分析显示肿瘤部位、胃切除方式、侵犯深度、淋巴结送检数目、淋巴结转移数目、淋巴结转移度是影响pN3胃癌预后的影响因子,多因素分析显示胃切除范围和肿瘤是否侵透浆膜是影响预后的独立影响因子.结论 对于pN3胃癌患者,侵及浆膜及全胃切除者,应给予更加积极的术后辅助治疗及随访观察;对于可行R0切除的患者,应尽量清扫多的淋巴结,改善预后;淋巴结转移度与淋巴结转移数目一样可以作为评估预后的指标.

Prognosis analysis of pN3 gastric cancer

Objective To further assess the prognostic differences in this group of patients through analysis of postoperative survival on patients with pN3 gastric cancer in this study. Methods The clinical data of 394 patients with gastric cancer from January 1980 to December 2005 were retrospectively analyzed. These patients were rendered successful R0 and D2＋ operation, pathologically confirmed as gastric adenocarcinoma after operation, and selected according to the seventh edition of UICC with the number of metastasis lymph node of more than 6 （pN3） and complete data of clinical pathology and follow up. Being diathesis affecting prognosis, the factors of clinical pathology were ren- dered univariate and multivariate analysis. Results The overall 5-year survival rate was 29%. Univariate analysis showed that tumor site, pattern of gastrectomy, depth of invasion, number of lymph node inspected, number of metasta- sis lymph node, and metastasis degree of lymph node were the influencing factor of prognosis of pN3 gastric cancer, while the multivariate analysis showed that the range of gastric resection and whether tumor penetrate through the serosa were the independent influencing factor of prognosis. Conclusion More active postoperative adjuvant therapy and follow up observation should be given to patients with pN3 gastric cancer invading the serosa and undergone total gastrectomy. The lymph nodes should be cleaned as much as possible to improve the prognosis of patients who are feasible for R0 resection. The metastasis degree of lymph node and the number of metastasis lymph node can be used as indicators to access prognosis.