淋巴结转移阴性的低分化和未分化胃腺癌的预后因素分析
림파결전이음성적저분화화미분화위선암적예후인소분석
Prognostic factors of low-and undifferentiated gastric cancer with negative metastasis of lymph nodes
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2014年 8期 629-632 ,共4页

    蒋楠%邓靖宇%刘勇%刘宏根%梁寒

    장남%산정우%류용%류굉근%량한

    胃肿瘤%淋巴结转移%预后因素 胃腫瘤%淋巴結轉移%預後因素
    위종류%림파결전이%예후인소
    Gastric neoplasms%Lymph node metastasis%Prognostic factor
    目的 探讨影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素.方法 回顾性分析2002年1月至2007年12月天津医科大学附属肿瘤医院收治的270例淋巴结转移阴性的低分化和未分化胃腺癌患者的临床病理资料.患者均行胃癌根治术,其中术中淋巴结清扫数目＜15枚的患者161例、15～20枚患者53例、21 ～30枚患者33例、＞30枚患者23例.采用门诊、电话、信件等方式进行随访.随访时间截至2013年10月.采用COX模型逐步后退法进行预后因素分析.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.结果 270例患者术后均获得随访,随访率为100.00％(270/270),中位随访时间为63个月(2～103个月).患者总体中位生存时间为63个月(2～103个月),1、3、5年总体生存率分别为93.0％ 、69.5％ 、58.5％.其中161例淋巴结清扫数目＜15枚患者中位生存时间为58个月(2～103个月),1、3、5年生存率分别为91.4％、59.3％、48.8％;53例淋巴结清扫数目15 ～ 20枚患者中位生存时间为68个月(4 ～95个月),1、3、5年生存率分别为94.3％、84.9％、71.7％;33例淋巴结清扫数目21～ 30枚患者中位生存时间为68个月(34 ～ 94个月),1、3、5年生存率分别为100.0％、97.0％、87.9％;23例淋巴结清扫数目＞30枚患者中位生存时间为60个月(2～84个月),1、3、5年生存率分别为87.5％、62.5％、54.2％.不同淋巴结清扫数目患者预后比较,差异有统计学意义(x2=25.077,P＜0.05).淋巴结清扫数目21 ～30枚患者预后优于15 ～20枚患者,差异有统计学意义(x2=3.924,P＜0.05);淋巴结清扫数目15 ～ 20枚患者预后优于＞30枚患者,差异有统计学意义(x2=4.454,P＜0.05);淋巴结清扫数日＞30枚患者与＜15枚患者预后比较,差异无统计学意义(x2=0.450,P＞0.05).单因素分析结果显示:患者性别、年龄、肿瘤部位、肿瘤直径、浆膜浸润、Borrmann分型、胃切除范围和淋巴结清扫数目是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的相关因素(x2=4.143,12.607,23.665,11.549,26.350,8.059,5.222,25.077,P＜0.05).多因素分析结果显示:肿瘤直径＞5 cm、浆膜浸润是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的独立危险因素(HR=1.842,3.084,95％可信区间:1.286～2.638,1.956～4.861,P ＜0.05);淋巴结清扫数目21 ～30枚是其预后的保护因素(HR=1.533,95％可信区间:1.229～2.248,P＜0.05).结论 行胃癌根治术时淋巴结清扫数目为21～ 30枚,可改善患者预后.肿瘤直径＞5 cm、浆膜浸润和淋巴结清扫数目＜15枚、15 ～ 20枚及＞30枚是影响淋巴结转移阴性的低分化和未分化胃腺癌患者预后的独立危险因素.
    목적 탐토영향림파결전이음성적저분화화미분화위선암환자예후적상관인소.방법 회고성분석2002년1월지2007년12월천진의과대학부속종류의원수치적270례림파결전이음성적저분화화미분화위선암환자적림상병리자료.환자균행위암근치술,기중술중림파결청소수목＜15매적환자161례、15～20매환자53례、21 ～30매환자33례、＞30매환자23례.채용문진、전화、신건등방식진행수방.수방시간절지2013년10월.채용COX모형축보후퇴법진행예후인소분석.채용Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험.결과 270례환자술후균획득수방,수방솔위100.00％(270/270),중위수방시간위63개월(2～103개월).환자총체중위생존시간위63개월(2～103개월),1、3、5년총체생존솔분별위93.0％ 、69.5％ 、58.5％.기중161례림파결청소수목＜15매환자중위생존시간위58개월(2～103개월),1、3、5년생존솔분별위91.4％、59.3％、48.8％;53례림파결청소수목15 ～ 20매환자중위생존시간위68개월(4 ～95개월),1、3、5년생존솔분별위94.3％、84.9％、71.7％;33례림파결청소수목21～ 30매환자중위생존시간위68개월(34 ～ 94개월),1、3、5년생존솔분별위100.0％、97.0％、87.9％;23례림파결청소수목＞30매환자중위생존시간위60개월(2～84개월),1、3、5년생존솔분별위87.5％、62.5％、54.2％.불동림파결청소수목환자예후비교,차이유통계학의의(x2=25.077,P＜0.05).림파결청소수목21 ～30매환자예후우우15 ～20매환자,차이유통계학의의(x2=3.924,P＜0.05);림파결청소수목15 ～ 20매환자예후우우＞30매환자,차이유통계학의의(x2=4.454,P＜0.05);림파결청소수일＞30매환자여＜15매환자예후비교,차이무통계학의의(x2=0.450,P＞0.05).단인소분석결과현시:환자성별、년령、종류부위、종류직경、장막침윤、Borrmann분형、위절제범위화림파결청소수목시영향림파결전이음성적저분화화미분화위선암환자예후적상관인소(x2=4.143,12.607,23.665,11.549,26.350,8.059,5.222,25.077,P＜0.05).다인소분석결과현시:종류직경＞5 cm、장막침윤시영향림파결전이음성적저분화화미분화위선암환자예후적독립위험인소(HR=1.842,3.084,95％가신구간:1.286～2.638,1.956～4.861,P ＜0.05);림파결청소수목21 ～30매시기예후적보호인소(HR=1.533,95％가신구간:1.229～2.248,P＜0.05).결론 행위암근치술시림파결청소수목위21～ 30매,가개선환자예후.종류직경＞5 cm、장막침윤화림파결청소수목＜15매、15 ～ 20매급＞30매시영향림파결전이음성적저분화화미분화위선암환자예후적독립위험인소.
    Objective To investigate the prognostic factors of low-and undifferentiated gastric cancer with negative metastasis of lymph nodes.Methods The clinicopathological data of 270 patients with low-and undifferentiated gastric cancer and negative metastasis of lymph nodes who were admitted to the Tianjin Cancer Hospital from January 2002 to December 2007 were retrospectively analyzed.All the patients received radical gastrectomy.One hundred and sixty-one patients had the number of lymph nodes dissected under 15,53 patients had 15-20 lymph nodes dissected,33 had 21-30 lymph nodes dissected and 23 patients with the number of lymph nodes dissected more than 30.Patients were followed up via out-patient examination,phone call and mail till October 2013.The prognosis analysis was done by COX step-wise regression.The survival curve was drawn by KaplanMeier method,and the survival was analyzed using the Log-rank test.Results All the patients were followed up for a median time of 63 months (range,2-103 months).The median survival time was 63 months (range,2-103 months),and the 1-,3-,5-year overall survival rates were 93.0％,69.5％ and 58.5％,respectively.The median survival time of the 161 patients with the number of lymph nodes dissected under 15 was 58 months (range,2-103 months),and the 1-,3-,5-year survival rates were 91.4％,59.3％ and 48.8％,respectively.The median survival time of the 53 patients with the number of lymph nodes dissected between 15 and 20 was 68 months (range,4-95 months),and the 1-,3-,5-year survival rates were 94.3％,84.9％ and 71.7％,respectively.The median survival time of the 33 patients with the number of lymph nodes dissected between 21 and 30 was 68 months (range,34-94 months),and the 1-,3-,5-year survival rates were 100.0％,97.0％ and 87.9％,respectively.The median survival time of the 23 patients with the number of lymph nodes dissected more than 30 was 60 months (range,2-84 months),and the 1-,3-,5-year survival rates were 87.5％,62.5％ and 54.2％,respectively.There was significant difference in the prognosis between the 4 groups (x2 =25.077,P ＜ 0.05).There was significant difference in the prognosis between patients who had 21-30 lymph nodes resected and those had 15-20 lymph nodes resected (x2=3.924,P ＜0.05).Significant difference was also observed in the prognosis between patients who had 15-20 lymph nodes resected and those had more than 30 lymph nodes resected (x2=4.454,P ＜ 0.05),while no significant difference was observed in the prognosis between patients who had lymph nodes resected more than 30 and those had lymph nodes resected less than 15 (x2=0.450,P ＞0.05).The results of univariate analysis showed that gender,age,location and diameter of the tumor,serosal invasion,Borrmann classification,range of gastric resection and the number of lymph nodes dissected were factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes (x2 =4.143,12.607,23.665,11.549,26.350,8.059,5.222,25.077,P ＜0.05).The results of multivariate analysis showed that the tumor diameter longer than 5 cm and serosal invasion were the independent factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes (HR =1.842,3.084,95％ confidence interval:1.286-2.638,1.956-4.861,P ＜ 0.05).Lymph nodes dissected for 21-30 was the protective factor of prognosis (HR =1.533,95％ confidence interval:1.229-2.248,P ＜ 0.05).Conclusions Lymph nodes dissected for 21-30 during radical gastrectomy may improve the long-term survival of patients.The tumor diameter longer than 5 cm,serosal invasion and the number of lymph nodes dissected (less than 15,15-20 and more than 30) were the independent factors influencing the prognosis of patients with low-and undifferentiated gastric cancer and with negative metastasis of lymph nodes.
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