分化不良型早期胃癌淋巴结转移的危险因素分析

目的评估分化不良型早期胃癌患者淋巴结转移的危险因素，探讨其内镜治疗的可能性。方法回顾性分析2002年9月-2008年12月经手术证实的100例分化不良型早期胃癌患者，对其年龄、性别、肿瘤大小、部位、大体类型、溃疡、组织学类型、浸润深度及淋巴管肿瘤浸润与淋巴结转移的关系进行单因素和多因素分析。结果分化不良型早期胃癌的淋巴结转移率达18．00％。多变量分析显示肿瘤大小（〉2cm）、侵犯至黏膜下层、淋巴管肿瘤浸润均是分化不良型早期胃癌淋巴结转移的独立危险因素（P〈0．05）。肿瘤大小和淋巴管肿瘤浸润是分化不良型黏膜内早期胃癌的淋巴结转移的独立危险因素。在直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内早期胃癌中未发现淋巴结转移。结论直径≤2cm且无淋巴管肿瘤浸润的分化不良型黏膜内癌患者可考虑内镜治疗，术后需密切随访。

Risk factors for lymph node metastasis in undifferentiated early gastric cancer

Objective To evaluate the risk factors of lymph node metastasis in undifferentiated early gastric cancer (EGC) and to explore the possibility of endoscopic resection. Methods The data of 100 un-differentiated EGC patients, surgically confirmed between September 2002 and December 2008, were re-trieved. Clinicopathologic factors including age, gender, tumor size, location, macroscopic type, ulceration, histological type, depth of tumor invasion and lymphatic involvement were investigated by univariate and mul-tivariate analyses for their possible relationship with lymph node metastasis. Results The incidence of lymph node metastasis was 18.00% in undifferentiated EGC. Multivariate analysis revealed that tumor diam-eter (>2.0cm), submucosal invasion and lymphatic involvement were independent risk factors of lymph node metastasis (P<0. 05, respectively). Tumor size and lymphatic involvement were significantly associat-ed with lymph node metastasis in cases of intramucosal EGC. Lymph node metastasis was not found in any patients of undifferentiated intramueosal EGC less than or equal to 2 em and without lymphatic involvement. Conclusion Endoscopic resection ean be considered in undifferentiated intramacosal EGC less than or equal to 2 cm and without lymphatic involvement with close follow-up.