CAJ | 학술논문

目的:评价局部进展期胃癌根治术后区域阴性淋巴结数目对术后无瘤生存期(diseasefree survival,DFS)的影响.方法:选取有明确术后病理资料且术后病理分期为T_3N_(0～2)M_0、随访资料完整、术后无瘤生存时间超过6个月的根治术后胃癌患者共485例,按照不同术后病理分期进行单独分组分析.Cox多因素回归分析筛选影响术后无瘤生存的因素,Kaplan-Meier方法绘制术后无瘤生存曲线,并比较各组中无瘤生存率间的差异.结果:Cox多因素回归分析表明,独立影响胃癌患者术后无瘤生存期的因素包括年龄、肿瘤分化程度、肿瘤部位以及术后病理中阴性淋巴结数目.在T_3N_0M_0组中,当阴性淋巴结分别为1～4枚和≥5枚时,患者2年无瘤生存率分别为8.3%和55.6%,3年无瘤生存率分别为0和24.9%(P=0.025);在T_3N_1M_0组中,当阴性淋巴结分别为≤3枚、4～9枚和≥10枚时,患者2年无瘤生存率分别为17.3%、39.1%和52.6%,3年无瘤生存率分别为4.2%、6.0%和17.1%(P<0.001):在T_3N_2M_0组中,当阴性淋巴结为≤7枚和≥8枚时,患者2年无瘤生存率分别为11.5%和35.0%,3年无瘤生存率分别为0.8%和5.0%(P=0.015).结论:对于术后病理分期为T_3N_(0～2)M_0的胃癌病例,术后病理资料中阴性淋巴结数目可反映区域淋巴结清扫的彻底性以及评价术后病理分期的准确性,是影响根治术后无瘤生存期的独立预后因素.
목적:평개국부진전기위암근치술후구역음성림파결수목대술후무류생존기(diseasefree survival,DFS)적영향.방법:선취유명학술후병리자료차술후병리분기위T_3N_(0～2)M_0、수방자료완정、술후무류생존시간초과6개월적근치술후위암환자공485례,안조불동술후병리분기진행단독분조분석.Cox다인소회귀분석사선영향술후무류생존적인소,Kaplan-Meier방법회제술후무류생존곡선,병비교각조중무류생존솔간적차이.결과:Cox다인소회귀분석표명,독립영향위암환자술후무류생존기적인소포괄년령、종류분화정도、종류부위이급술후병리중음성림파결수목.재T_3N_0M_0조중,당음성림파결분별위1～4매화≥5매시,환자2년무류생존솔분별위8.3%화55.6%,3년무류생존솔분별위0화24.9%(P=0.025);재T_3N_1M_0조중,당음성림파결분별위≤3매、4～9매화≥10매시,환자2년무류생존솔분별위17.3%、39.1%화52.6%,3년무류생존솔분별위4.2%、6.0%화17.1%(P<0.001):재T_3N_2M_0조중,당음성림파결위≤7매화≥8매시,환자2년무류생존솔분별위11.5%화35.0%,3년무류생존솔분별위0.8%화5.0%(P=0.015).결론:대우술후병리분기위T_3N_(0～2)M_0적위암병례,술후병리자료중음성림파결수목가반영구역림파결청소적철저성이급평개술후병리분기적준학성,시영향근치술후무류생존기적독립예후인소.
Objective: To evaluate the impact of the number of negative lymph nodes on disease free survival (DFS) of patients with locally advanced gastric cancer. Methods: A total of 485 patients who underwent surgery for gastric cancer were enrolled in this study. We analyzed the data of these patients including complete information of follow-up and definite postoperative pathological results. The disease free survival of all patients was more than 6 months and was analyzed according to the pathological stage respectively. COX regression analysis was performed to screen the independent prognostic factors. Kaplan-Meier method was used to draw the disease free survival curve and the disease free survival rate was compared among subgroups. Results: Cox regression analysis showed that the disease free survival rate of gastric cancer patients with pathological stage T_3N_(0～2)M_0 was significantly associated with age, degree of tumor differentiation, tumor location as well as the number of negative lymph nodes. In the T_3N_0M_0 subgroup, when the number of negative lymph nodes was 1 to 4 and 5 or more, the 2-year disease free survival rate was 8.3% and 55.6%, respectively, and the 3-year disease free survival rate was 0 and 24.9%, respectively (P=0.025).In the T_3N_1M_0 subgroup, when the number of negative lymph nodes was 3 or less, 4 to 9, and 10 or more, the 2-year disease free survival rate was 17.3%, 39.1%, and 52.6%, respectively, and the 3-year disease free survival rate was 4.2%, 6.0%, and 17.1%, respectively (P<0.001). In the T_3N_1M_0 subgroup, when the number of negative lymph nodes was 7 or less and 8 or more, the 2-year disease free survival rate was 11.5% and 35%, respectively, and the 3-year disease free survival rate was 0.8% and 5%, respectively (P=0.015).Conclusion: For gastric cancer patients with pathological stage T_3N_(0～2)M_0, the number of negative nodes could reflect the level of regional lymph node dissection. The number of negative nodes can be an index for evaluation of the accuracy of pathological staging and is considered as an independent prognostic factor for disease free survival of gastric cancer patients.