病理N3期胃癌310例预后分析

目的探讨UICC第7版TNM分期标准中病理N3（pN3）期胃癌患者的预后特征及预后影响因素。方法回顾性分析2000年1月至2006年12月间天津医科大学附属肿瘤医院收治的实施胃癌根治术或扩大根治术的310例pN3期胃癌患者的临床病理和随访资料，分别采用Logrank检验和Cox比例风险模型进行单因素和多因素预后分析。结果310例患者均获随访，随访时间为2～103（平均35．7）月，术后5年生存率为14．6％。其中pN3a期201例，pN3b期109例，5年生存率分别为16．8％和10．3％，差异有统计学意义（P=0．013）。单因素预后分析显示，肿瘤部位、Borrmann分型、pT分期、pN分期、淋巴结转移率及手术方式与患者预后有关（均P〈0．05）。多因素分析显示，浸润深度、手术方式及淋巴结转移率是影响预后的独立危险因素（均P〈0．01），而pN分期并不是独立的预后影响因素（P=0．658）。按浸润深度对患者进行分层分析显示，对于210例pT4a期患者，pN3a和pN3b亚组5年生存率分别为16．1％和12．8％，差异有统计学意义（P=0．001）；但对于88例pT4b期患者，pN3a和pN，b亚组5年生存率的差异则无统计学意义（8．6％比3．1％，P=0．137）。结论pM期胃癌患者预后较差，肿瘤浸润深度和不同手术方式是影响其预后的重要因素，淋巴结转移率对判断pM期胃癌预后有重要意义。第7版TNM分期中pN3分期能较好反映患者的预后情况。

Prognosis analysis of 310 patients with pathological stage pN3 gastric cancer

Objective To investigate the clinicopathological characteristics and prognostic factors of patients with pathological stage pN3 gastric cancer. Methods A retrospective study of 310 patients with histologically confirmed pN3 stage gastric cancer undergoing radical gastrectomy from January 2000 to December 2006 in our department was performed. The Kaplan-Meier method was used to analyze the survival. Log-rank test and Cox regression model were carried out for univariate and multivariate analyses. Results All the patients were followed up for 2 to 103 （mean 35.7） months. The overall 5-year survival rate was 14.6%. There were 201 cases with stage pN3a and 109 cases with stage pN3b, and the 5-year survival rates were 16.8% and 10.3% respectively（P=0.013）. Univariate analysis showed that tumor location, Borrmann type, depth of tumor invasion, surgical method, metastatic lymph node ratio, and pN stage were associated with postoperative survival （all P〈0.05）. The multivariate analysis revealed that depth of tumor invasion, surgical method and metastatic lymph node ratio were independent prognostic factors, while the pN stage was not. The difference of 5-year survival rate between pN3a and pN3b subgroups was significant in pT4a patients（16.1% vs. 12.8%, P=0.001）, while such difference was not significant in pT4b patients （8.6% vs. 3.1%, P=0.137）. Conclusions Prognosis of patients with pN3 stage gastric cancer after radical resection is poor. Depth of tumor invasion and surgical method are independent prognostic factors for pN3 stage gastric cancer. Metastatic lymph node ratio is valuable to predict the prognosis of pN3 stage patients. The pN3 staging of the 7th UICC provides a more accurate prediction of prognosis.