早期远端胃印戒细胞癌淋巴结转移的危险因素分析及外科手术指征探讨

目的研究早期远端胃印戒细胞癌淋巴结转移的危险因素,进一步分析其外科手术指征。方法回顾性分析2013年3月至2018年11月期间在苏州大学附属第一医院普外科接受外科根治手术且术后病理学检查证实为远端胃印戒细胞癌的91例早期胃癌患者的临床资料,收集患者的性别、年龄、肿瘤最大径、病灶数量、浸润深度、肿瘤大体外观、脉管癌栓、合并溃疡等数据,探索发生淋巴结转移的危险因素,进一步分析外科手术指征。结果91例早期远端胃印戒细胞癌均接受了外科根治性手术,其中淋巴结转移10例。单因素分析结果显示,肿瘤最大径(χ^2=5.631,P=0.025)、浸润深度(χ^2=4.389,P=0.016)、病灶数量(χ^2=5.615,P=0.023)及脉管癌栓(χ^2=22.500,P=0.001)均与早期远端胃印戒细胞癌的淋巴结转移有关。多因素分析结果显示,肿瘤最大径(OR=3.675,P=0.012)、浸润深度(OR=3.886,P=0.015)及脉管癌栓(OR=8.711,P<0.001)是早期远端胃印戒细胞癌发生淋巴结转移的影响因素,肿瘤最大径≥2 cm、浸润至黏膜下层及有脉管癌栓的患者有更高的淋巴结转移率。结论肿瘤最大径≥2 cm、浸润至黏膜下层及存在脉管癌栓的早期远端胃印戒细胞癌患者有更高的淋巴结转移风险;满足肿瘤最大径≥2 cm和存在脉管癌栓中任何1项条件者均可能需接受外科根治性手术。

The risk factors of lymph node metastasis for early gastric signet ring cell cancer and its indications of radical surgery

Objective To investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer and indications of radical surgery.Methods From Mar.2013 to Nov.2018,a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection,and proved postoperatively for early distal gastric signet ring cell cancer in the First Affiliated Hospital of Soochow University were enrolled in this study.We collected clinicpathologic characteristics,such as gender,age,maximum diameter of tumor,number of lesions,depth of invasion,macroscopic type,and lymphovascular invasion,to explore the risk factors of lymph node metastasis and further analyze the indication of radical surgery.Results All 91 patients accepted radical gestrectomy and regional lymph node dissection,10 patients suffered from lymph node metastasis.Univariate analysis showed a positive relationship between maximum diameter of tumor(χ^2=5.631,P=0.025),depth of invasion(χ^2=4.389,P=0.016),number of lesions(χ^2=5.615,P=0.023),and lymphovascular invasion(χ^2=22.500,P=0.001)and lymph node metastasis of early distal gastric signet ring cell cancer.The multivariate analysis revealed that maximum diameter of tumor(OR=3.675,P=0.012),depth of invasion(OR=3.886,P=0.015),and lymphovascular invasion(OR=8.711,P<0.001)were independent risk factors of lymph node metastasis.Conclusions The risk of lymph node metastasis of early distal gastric signet ring cell cancer was high in those with tumor diameter≥2 cm,submucosal cancer,and lymphovascular invasion.Radical surgery might be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criteria:tumor diameter≥2 cm and lymphovascular invasion.