摘要
目的:探讨影响早期胃癌伴有淋巴结转移患者远期预后的独立危险因素,评估淋巴结转移数量对预后影响的优化分类方法。方法:回顾分析2005年2月至2021年12月外科手术治疗并经术后病理证实为早期胃癌淋巴结转移的348例患者的临床病理资料,依据第八版美国癌症联合委员会指南N分期标准分为T1N1与T1N2+组,其中T1N1组140例,T1N2+组208例。采用Cox回归分析,探讨影响早期胃癌伴有淋巴结转移患者远期预后的独立危险因素,并通过log-rank检验筛选淋巴结转移数量对预后影响的最优分类。结果:T1N1组3年总体生存率高于T1N2+组(83.9%vs.61.9%),差异有统计学意义(P<0.01)。单因素COX回归分析结果显示,患者年龄、N分期、肿瘤大小、脉管癌栓与早期胃癌伴淋巴结转移患者的远期预后相关(P<0.05)。多因素分析结果显示,年龄≥60岁(P=0.04)、肿瘤N分期较晚(P=0.002)、肿瘤>3 cm(P=0.016)是影响总体生存的独立危险因素。进一步以淋巴结转移数量为截断点进行log-rank检验,结果表明,淋巴结转移数量等于6时,log-rank检验的χ^(2)值最大(77.5%vs.56.0%,log-rankχ^(2)=23.109,P<0.001),有助于更好地区分不良预后患者。结论:对于早期胃癌淋巴结转移的患者,年龄≥60岁、肿瘤>3 cm、肿瘤N分期较晚是影响远期预后的独立危险因素。其中淋巴结转移数量等于6可作为反映早期胃癌淋巴结转移预后的有效分类指标。
Objective:To explore the independent risk factors affecting the long-term prognosis of early gastric cancer patients with lymph node metastasis(LNM),and to evaluate the optimal classification of the LNM number influence on prognosis.Methods:The clinicopathologic data of 348 patients with early gastric cancer and LNM who underwent operation from Feb.2005 to Dec.2021 were retrospectively analyzed.Patients were divided into T1N1and T1N2+groups according to the 8th edition of American joint committee on cancer guidelines.There were 140 cases in the T1N1group and 208 cases in the T1N2+group.Cox regression analysis was used to identify the independent risk factors affecting the long-term prognosis of patients with early gastric cancer and LNM,and the log-rank test was used to determine the optimal classification of the number of LNM affecting the overall survival.Results:The 3-year overall survival rate in the T1N1group was higher than that in the T1N2+group(83.9%vs.61.9%),and the difference was statistically significant(P<0.01).Univariate COX regression analysis showed that the age,N stage,tumor diameter and vascular cancer thrombus were correlated with the long-term prognosis of patients with LNM(P<0.05).Multivariate results showed that age≥60 years(P=0.04),poor pathological N stage(P=0.002)and tumor diameter>3 cm(P=0.016)were independent risk factors for overall survival.The log-rankχ^(2) test was performed with the number of LNM as the cut-off point.The results showed that when the number of LNM was equal to 6,theχ^(2) value of the log-rank test was the largest(3-year survival rate:77.5%vs.56.0%,log-rankχ^(2)=23.109,P<0.001),which was helpful to better distinguish patients with poor prognosis.Conclusions:For patients with early gastric cancer and LNM,age≥60 years,tumor diameter>3 cm,and poor pathological N stage are independent risk factors for long-term prognosis.The number of LNM equal to 6 can be used as an effective classification index to reflect the prognosis of LNM in early gastric cancer.
作者
宋立强
崔昊
梁文全
刘贵宾
曹博
黄俊
袁震
卫勃
SONG Li-qiang;CUI Hao;LIANG Wen-quan(Department of General Surgery,the First Medical Center&Institute of General Surgery,Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University)
出处
《腹腔镜外科杂志》
2023年第1期41-45,共5页
Journal of Laparoscopic Surgery
基金
国家重点研发项目(2019YFB1311505)
国家自然科学基金(82273231)
国家自然科学基金(82073192)
北京市科委计划项目(Z221100007422125)。
关键词
胃肿瘤
淋巴转移
预后
影响因素分析
Stomach neoplasms
Lymphatic metastasis
Prognosis
Root cause analysis
