淋巴结转移率对胃癌患者预后的评估价值

目的 探讨淋巴结转移率（rN）对胃癌根治术患者预后的评估价值.方法 回顾性分析1980-2006年间中国医科大学附属第一医院肿瘤外科收治的接受根治性手术的710例胃癌患者的临床资料.按淋巴结捡取数目将710例患者分为少于15枚组（327例）和15枚以上（含15枚）组（383例）.按淋巴结转移率进行rN分期;按淋巴结转移数量进行pN分期.分别采用Logrank检验和Cox比例风险模型来进行单因素和多因素预后分析.结果 少于15枚组和15枚以上组胃癌患者中位生存时间分别为74个月（95％ CI：55.6～92.4个月）和96个月（95％ CI：77.8～119.2个月）,差异无统计学意义（P＞0.05）.多因素预后分析显示,rN分期既是少于15枚组（P＜0.01,RR=1.225,95％ CI：1.102～1.362）,又是15枚以上组（P＜0.01,RR=1.421,95％ CI：1.269～1.592）胃癌患者的独立预后因素;而pN分期仅仅是少于15枚组胃癌患者的独立预后因素（P＜0.01,RR=1.475,95％ CI：1.168～1.863）.采用rN分期系统,相同分期的两组胃癌患者生存时间的差异均无统计学意义（P＞0.05）;而采用pN分期系统,在pN1期患者中少于15枚组患者生存时间明显短于15枚以上组（P＜0.01）.结论 淋巴结转移率是影响胃癌预后的独立因素.在判断胃癌预后中,按淋巴结转移率的rN分期不受检出淋巴结数目的限制,较pN分期系统更为可靠.

Prognostic value of metastatic lymph node ratio in gastric cancer

Objectives To evaluate the value of the metastatic to examined lymph nodes（rN） ratio in gastric cancer patients who underwent radical resection.Methods In this retrospective study, data were collected from the medical records of 710 patients who underwent radical gastrectomy （R0） for gastric cancer from 1980 to 2006 in the Department of Surgical Oncology at the First Affiliated Hospital of China Medical University.The patients were divided into 2 groups according to the number of examined lymph nodes：Group 1 consisted of 327 patients with 〈15 examined lymph nodes and Group 2 consisted of 383 patients with ≥ 15 lymph nodes,rN categories staging and pN categories were divided separately according to the metastatic lymph node ratio and the examined lymph nodes.The prognostic factors were analyzed by univariate （Log-rank） and multivariate （Cox model） analysis methods.Results The median survival time was 74 months （95% CI：55.6-92.4 months） in Group 1 and 96 months （95% CI：77.8-119.2 months） in Group 2,and the difference was not statistically significant （P〉0.05）.On multivariate analysis,the N ratio remained as an independent prognostic factor in both Group 1 （P〈0.01,RR=1.225,95% CI：1.102-1.362） and Group 2 （P〈0.01,RR=1.421,95% CI：1.269-1.592）.However,pN stage was an independent prognostic factor only in Group 1.When the rN ratio classification was applied,there were no significant differences between each categories （P〉0.05）.However,the overall survival of patients with pN1 disease in Group 1 was significantly shorter than that in Group 2 according to the pN stage classification（P〈0.01 ）.Conclusions The metastatic lymph node ratio is an independent prognostic factor of the prognosis of gastric cancer.The staging system based on metastatic lymph node ratio（rN） is more reliable than the system based on the number of metastatic lymph nodes in the prediction of the prognosis of gastric cancer.