贲门腺癌淋巴结转移及分站的COX模型多因素分析(附736例报告)

目的探讨贲门腺癌淋巴结转移（ＬＮＭ）规律及分站标准。方法依据预后、转移率及转移度指标，对７３６例经手术切除，术后生存≥３个月的贲门腺癌患者的ＬＮＭ资料，进行ＣＯＸ模型多因素分析。结果（１）最重要预后因素为：转移度、胃左动脉旁ＬＮＭ、胃小弯旁ＬＮＭ和贲门旁ＬＮＭ；（２）无ＬＮＭ组预后较好（Ｐ＜０．００１）；（３）ＬＮＭ有一相对固定的途径，单一部位ＬＮＭ组与多部位ＬＮＭ组间转移率和转移度差异均有显著性（Ｐ＜０．０５）；（４）按胃左动脉旁、胃小弯旁及贲门旁不同ＬＮＭ情况分组，第１组（单一贲门旁ＬＮＭ和单一胃小弯旁ＬＮＭ），第２组（单一胃左动脉旁ＬＮＭ，贲门及胃小弯旁同时ＬＮＭ），及第３组（与胃左动脉旁有关的多部位ＬＮＭ）间转移度差异有显著性（Ｐ＜０．０５）。结论（１）ＬＮＭ以肿瘤为中心，由近及远，由单一部位、单个淋巴结到多部位、多个淋巴结扩散转移。（２）依转移度的不同建议将以上３组分别归为第１，２，３站。

Extent and mode of metastatic spread to lymph nodes in patients with adenocarcinoma of the gastric cardia: a multivariate analysis using COX proportion hazard model

Objective To investigate lymph node metastases (LNM) and assess LNM level accurately after standard resection.Methods An analysis was done in 736 patients with resected gastric cardia cancer whose postoperative survival time was longer than three months, through comparison of prognosis, frequency of LNM and ratio of the number of invaded to removed lymph nodes (I/R), using COX multivariate analysis model. Results (1) The most important prognostic variables were I/R, left gastric artery LNM, lesser curvature LNM, and paracardia LNM. (2) The patients without LNM had better survival ( P <0.001). (3) There were a relatively regular way of LNM and significant difference between LNM of single site and that of multiple sites on the frequency of LNM and I/R, respectively ( P < 0.05). (4) There was significantly different I/R among group 1 (single paracardia LNM and single lesser curvature LNM), group 2 (single left gastric artery LNM and paracardia plus lesser curvature LNM) and group 3 (multiple sites in association with left gastric artery LNM) ( P <0.05). Conclusion The dissemination of LNM seems to be as follows: from paracardia lymph nodes to distant lymph nodes, and from a single lymph node of one site to multiple sites with many lymph notes involved. It is suggested that group 1 LNM belongs to station 1, group 2 LNM to station 2 and group 3 LNM to station 3 according to their I/R.