胃癌患者No.14v淋巴结转移或微转移与临床病理特征及预后关系研究

目的探讨胃癌患者No.14v淋巴结转移或微转移与临床病理特征及预后的关系。 方法回顾性分析2018年1月至2020年12月行胃癌D2+根治术（联合No.14v淋巴结清扫）的128例胃癌患者临床资料。数据应用软件SPSS 22.0进行处理，单因素分析等级计数资料行秩和检验，其他计数资料行χ²检验；多因素分析行Logistic回归分析；生存情况采用Kaplan-Meier法并行Log-Rank检验。P<0.05为差异有统计学意义。 结果128例胃癌患者中，病理学检查发现No.14v淋巴结转移者19例（14.8%），No.14v淋巴结阴性者109例，免疫组织化学检查发现No.14v淋巴结微转移者5例（3.9%），No.14v淋巴结的总转移率为18.8%。单、多因素分析结果显示，胃下部肿瘤、Borrmann分型Ⅲ-Ⅳ型、pN₃期、脉管浸润及No.6淋巴结转移是胃癌患者No.14v淋巴结转移或微转移的独立危险因素（P<0.05）。术后中位随访时间27个月，转移组与非转移组患者的累积总生存率（37.5% vs. 77.9%）及无病生存率（29.2% vs. 76.0%）比较，差异有统计学意义（Log-Rank χ²=16.142、28.691，P=0.000、0.000）。 结论胃癌患者No.14v淋巴结转移或微转移与胃下部肿瘤、Borrmann分型Ⅲ-Ⅳ型、pN₃期、脉管浸润、No.6淋巴结转移等临床病理特征密切相关，且伴有No.14v淋巴结转移或微转移的胃癌患者预后较差。

The relationship between No. 14v lymph node metastasis or micrometastasis and clinicopathological characteristics and prognosis of gastric cancer patients

ObjectiveTo investigate the relationship between No.14v lymph node metastasis or micrometastasis and clinicopathological features and prognosis in patients with gastric cancer. MethodsThe clinical data of 128 patients with gastric cancer who underwent D2 + radical gastrectomy（combined with No.14v lymph node dissection）from January 2018 to December 2020 were analyzed retrospectively.The data were processed by SPSS 22.0 software. Rank sum test was used for rank count data in univariate analysis χ² inspection；Logistic regression analysis was performed by multivariate analysis；Kaplan-Meier method and Log-Rank test were used for survival. P < 0.05 was statistically significant. ResultsAmong 128 patients with gastric cancer，19 cases（14.8%）had No.14v lymph node metastasis，and 5 cases（3.9%）had No.14v lymph node micrometastasis by immunohistochemical detection of negative No.14v lymph node. The total metastasis rate of No.14v lymph node was 18.8%. Multivariate Logistic regression analysis showed that lower gastric tumor，Borrmann type Ⅲ-Ⅳ，pN₃ stage，vascular invasion and No.6 lymph node metastasis were independent risk factors for No.14v lymph node metastasis or micrometastasis in gastric cancer patients（P<0.05），while tumor diameter >5 cm，vascular invasion and No.6 lymph node metastasis were independent risk factors for No.14v lymph node metastasis or micrometastasis in gastric cancer patients（P<0.05）. The median follow-up was 27 months，Kaplan-Meier analysis showed that the cumulative overall survival rate（37.5% vs. 77.9%）and disease-free survival rate（29.2% vs. 76.0%）between the metastasis group and the non metastasis group were statistically significant（Log-rank χ²=16.142，28.691，P=0.000，0.000）. ConclusionNo.14v lymph node metastasis or micrometastasis in gastric cancer patients is closely related to the clinicopathological features of lower gastric cancer，Borrmann type Ⅲ-Ⅳ，pN₃ stage，vascular invasion，No.6 lymph node metastasis，and the prognosis of gastric cancer patients with No.14v lymph node metastasis or micrometastasis is poor.