早期胃癌淋巴结转移多因素分析

目的探讨早期胃癌淋巴结转移规律，为微创治疗、缩小手术范围提供依据。方法对解放军总医院1983-2005年间诊治的308例早期胃癌患者进行回顾性分析，其中282例术后找到淋巴结，对其年龄，性别，肿瘤大小、部位、大体类型、分化程度、浸润深度，淋巴管癌栓，癌旁黏膜萎缩、肠化、异型增生等与淋巴结转移的关系进行单因素及多因素分析。结果早期胃癌淋巴结转移率为9．9％（28／282），黏膜（M）癌淋巴结转移率为2．5％（4／157），黏膜下层（SM）癌淋巴结转移率为19．2％（24／125）。Logistic回归分析提示，淋巴管癌栓（P=0．000，OR=8．568）、浸润黏膜下层（P=0．018，OR=4．234）、肿瘤〉2cm（P=0．020，OR=4．12）、分化不良（P=0．040，OR-2．710）为淋巴结转移的独立危险因子。进一步分层分析提示，影响M癌淋巴结转移的因素为肿瘤大小、淋巴管癌栓，≤2cm的M癌不论分化程度如何均无淋巴管癌栓，也无淋巴结转移（0／108），2-4cm、无淋巴管癌栓的M癌不论分化程度如何均无淋巴结转移（0／26）；影响SM癌淋巴结的因素为肿瘤大小、组织学类型、淋巴管癌栓，≤2cm、分化良好型、无淋巴管癌栓的SM癌均无淋巴结转移（0／25），2era、分化不良型、有淋巴管癌栓的SM癌淋巴结转移率72．7％（8／11）。结论肿瘤大小、淋巴管癌栓与M癌淋巴结转移相关，肿瘤大小、组织学类型、淋巴管癌栓与SM癌淋巴结转移相关。

Multivariate analysis of lymph node metastasis in patients with early gastric cancer

Objective To analyze the risk factors of regional lymph node metastasis in patients with early gastric cancer. Methods 308 patients surgically treated for early gastric cancer from 1983 to 2005 were analyzed retrospectively. Lymph nodes were found in 282 patients after radical resection. Eleven clinicopathologic variables such as age, gender, tumor size, location, macroscopic type, histopathological type, depth of invasion, lymphatic vessel involvement, paracarcinomatous mucosal atrophy, intestinal metaplasia and dysplasia were investigated by using chi-square test and logistic regression analysis for the possible relationship to lymph node metastasis. Results The rates of lymph node metastasis in early gastric cancer, mucosal cancer and submucosal cancer were 9.9% (28/282), 2.5% (4/157) and 19.2% (24/125), respectively. In the multivariate logistic regression model, lymphatic vessel involvement (P=0.000,OR=8.568), submucosal invasion (P=0.018, OR=4.234), a larger tumor size (>2cm) (P=0.020, OR=4.12) and undifferentiated type (P=0.040,OR=2.710) were found to be independent risk factors for lymph node metastasis in early gastric cancer. To analyze subgroup, lymphatic vessel involvement and a larger tumor size (>2cm) were significantly related to lymph node metastasis in mucosal cancer. The histopathological type did not have significant correlation with lymph node metastasis in mucosal cancer. Tumor size of 2cm or less in mucosal cancer was found to have no lymph node metastasis and lymphatic vessel involvement (0/108). Tumor size between 2cm and 4cm without lymphatic vessel involvement in mucosal cancer was found to have no lymph node metastasis (0/26). Lymphatic vessel involvement, a larger tumor size (>2cm) and undifferentiated type were significantly related to lymph node metastasis in submucosal cancer. No lymph node metastasis was observed in 25 patients with submucosal invasion who showed none of the three risk factors, whereas 72.7% (8/11) of patients with all the three factors had lymph node metastasis. Conclusion The tumor size and lymphatic vessel involvement are related with lymph node metastasis in mucosal cancer. Poor differentiation, tumor size and lymphatic vessel involvement are related with lymph node metastasis in submucosal cancer.