CAJ | 학술논문

目的探讨早期胃癌(EGC)临床病理特征和淋巴结转移规律及其对预后的影响.方法回顾性分析1995年10月至2005年10月间经手术治疗的157例EGC的临床病理特征和淋巴结转移规律及患者3年、5年的生存率.结果 157例EGC患者有22例(14%)伴有淋巴结转移,其中黏膜癌2例(2.4%),仅累及N.淋巴结;黏膜下癌20例(27.0%),除累及N1淋巴结外,有7例同时累及N2淋巴结;两者比较,差异有统计学意义(P<0.01).微小胃癌(直径小于或等于0.5 cm)者未见有淋巴结转移:直径小于或等于2.0 cm和大于2.0 cm的胃癌患者.淋巴结转移率分别为6.4%和21.5%;两者比较,差异有统计学意义(P<0.01).高分化EGC未见淋巴结转移;中分化及低分化EGC的淋巴结转移率分别为11.1%和20.9%;两者比较,差异有统计学意义(P<0.01).有9例出现脉管癌栓,其中4例伴淋巴结转移.Logistic回归多因素分析结果显示,肿瘤大小、分化程度、浸润深度、脉管癌栓均为影响EGC淋巴结转移的独立因素.伴有淋巴结转移的EGC患者3年、5年生存率分别为81.6%和79.5%,明显低于无淋巴结转移者的95.7%和93.2%(P<0.01).结论 EGC的淋巴结转移主要与肿瘤浸润深度、肿瘤大小、脉管癌栓及肿瘤分化程度密切相关.应根据淋巴结转移的风险合理选择EGC的治疗方式.
목적 탐토조기위암(EGC)림상병리특정화림파결전이규률급기대예후적영향.방법 회고성분석1995년10월지2005년10월간경수술치료적157례EGC적림상병리특정화림파결전이규률급환자3년、5년적생존솔.결과 157례EGC환자유22례(14%)반유림파결전이,기중점막암2례(2.4%),부루급N.림파결;점막하암20례(27.0%),제루급N1림파결외,유7례동시루급N2림파결;량자비교,차이유통계학의의(P<0.01).미소위암(직경소우혹등우0.5 cm)자미견유림파결전이:직경소우혹등우2.0 cm화대우2.0 cm적위암환자.림파결전이솔분별위6.4%화21.5%;량자비교,차이유통계학의의(P<0.01).고분화EGC미견림파결전이;중분화급저분화EGC적림파결전이솔분별위11.1%화20.9%;량자비교,차이유통계학의의(P<0.01).유9례출현맥관암전,기중4례반림파결전이.Logistic회귀다인소분석결과현시,종류대소、분화정도、침윤심도、맥관암전균위영향EGC림파결전이적독립인소.반유림파결전이적EGC환자3년、5년생존솔분별위81.6%화79.5%,명현저우무림파결전이자적95.7%화93.2%(P<0.01).결론 EGC적림파결전이주요여종류침윤심도、종류대소、맥관암전급종류분화정도밀절상관.응근거림파결전이적풍험합리선택EGC적치료방식.
Objective To explore the pattern of lymph node metastasis and its influence on the prognosis of early gastric cancer(EGC). Methods The pattern of lymph node metastasis and the 3-,5-year survival rates in 157 EGC patients undergone surgery from October 1995 to October 2005 were analyzed retrospectively. The SPSS 11.5 statistics software was used to perform univariate and multivariate analysis. Results Twenty-two cases had lymph node metastasis among 157 EGC patients (14%). Two mucous cancers (2.4%) and 20 submucosal tumors (27.0%) had lymph node metastases (P<0.01). Lymph node metastasis was not seen in minute gastric cancer (diameter ≤0.5 cm). Lymph node metastasis rates were 6.4% in the cancers with diameter 1.1-2.0 cm and 21.5% in the cancers with the diameter >2.0 cm (P<0.01). Besides, lymph node metastasis rate of well-differentiated EGC was O, of moderate differentiated EGC 11.1%, and poor-differentiated EGC 0.9% (P<0.01). Of 9 cases with vascular cancer embolus, 4 had lymph node metastases. Logistic regression analysis showed that tumor size, vascular cancer embolus, histopathological type and depth of invasion were independent factors of lymph node metastasis in EGC. The 3- and 5-year survival rates of EGC patients with lymph node metastasis were 81.6 % and 79.5% respectively,which were much lower than those without lymph node metastasis (95.7% and 93.2%, P<0.01).Conclusions Lymph node metastasis in EGC is mainly correlated with depth of infiltration, tumor size,vascular cancer embolus and differentiation. For EGC treatment, choice should be made reasonably based on the risk of lymph node metastasis.