早期胃癌淋巴结转移规律及影响因素

目的 探讨早期胃癌的淋巴结转移规律,为合理制定手术方案提供依据.方法 回顾性分析1991年1月至2010年12月间在天津医科大学附属肿瘤医院行开腹手术治疗的242例早期胃癌患者的临床病理资料,分析其淋巴结转移规律,并采用Logistic回归模型分析早期胃癌淋巴结转移的高危因素.结果 242例患者淋巴结转移率为9.1％(22/242),其中黏膜内癌为5.5％(10/182),黏膜下癌为20.0％(12/60).14例患者仅第1站淋巴结转移,4例出现跳跃性转移,4例同时出现第1站和第2站甚至第3站淋巴结转移.第1站淋巴结转移18例,以第7组和第3组转移频次最高,各8例;第2站淋巴结转移7例,局限于第8a组(4例)和第9组(3例);第3站淋巴结转移2例,第4sa组和第16b组各1例.多因素分析显示,肿瘤浸润深度(P=0.003,OR=4.386,95％CI:1.656～11.617)和有无脉管瘤栓(P=0.002,OR=13.621,95％CI:2.711～68.447)是早期胃癌淋巴结转移的独立危险因素.结论 早期胃癌的淋巴结转移与肿瘤浸润深度和脉管瘤栓密切相关;术前和术中正确评估早期胃癌的淋巴结转移状态对于手术方案的合理制订至关重要.

Mode of lymph node metastasis in early gastric cancer and risk factors

Objective To investigate the status of lymph node metastasis （LNM） and to discuss reasonable lymphadenectomy in early gastric cancer （EGC）. Methods Between January 1991 and December 2010, 242 EGC patients underwent surge in the Tianjin Cancer Hospital. Their clinical characteristics, pathologic features, and lymph node metastasis were analyzed retrospectively. Results LNM was observed in 22 of 242 patients（9.1%）, and 10（5.5%） in 182 mucosal lesions and 12 （20.0%） in 60 submueosal lesions. There were 14 patients had LNM in the first tier alone, 4 patients had skipped metastasis, and 4 patients had LNM in the first, second, and third ties. The LNM was identified in 18 patients at the first tier with groups 7 and 3 being the most common（8 patients in each group）, 7 patients at the second tier （4 patients in group 8a and 3 in group 9）, and 2 patients at the third tier （one 16b, and one 4sa）. Muhivariable analysis showed that the depth of invasion （P=0.003, 0R=4.386, 95%CI：1.656-11.617）, and lymphatic vessel involvement （P=0.002, OR= 13.621, 95%CI： 2.711-68.447） were independent risk factors for LNM. Conclusions LNM in EGC is mainly correlated with depth of invasion, and lymphatic vessel involvement. Precise evaluation of LNM pre- and intra-operatively is very important for the reasonable surgery＋.