未分化型早期胃癌淋巴结转移预测因素分析
摘要
目的:分析未分化型早期胃癌淋巴结转移的预测因素。方法:选择我院经术后病理检查证实的未分化型早期胃癌360例,分析淋巴结转移的相关因素。结果:本组未分化型早期胃癌淋巴结转移率17.2%;肿瘤直径>2cm、肿瘤侵及黏膜下层、脉管浸润者的淋巴结转移率显著增加(P<0.05);Logistic多元逐步回归分析结果显示,肿瘤浸润深度、肿瘤大小、脉管浸润进入以未分化型早期胃癌淋巴结转移为因变量的回归方程(P<0.05)。根据肿瘤浸润深度和大小,未分化型早期胃癌可分为低危组(肿瘤≤2cm且位于黏膜层),中危组(肿瘤>2cm且位于黏膜层或肿瘤≤2cm且位于黏膜下层)和高危组(肿瘤>2cm且位于黏膜下层)。结论:肿瘤>2cm、黏膜下层侵犯、脉管浸润是未分化型早期胃癌淋巴结转移的独立危险因素;低危组未分化型早期胃癌可考虑行内镜下治疗。
引文
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[2]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3)[J].Gastric Cancer,2011,14(2):113-123.
[3]吴巍,吴云林,孙萍胡,等.早期胃癌手术率的演变及经验[J].胃肠病学和肝病学杂志,2008,17(3):205-208.
[4]郝晋雍,黄晓俊,王祥,等.内镜黏膜下剥离术对早期胃癌及癌前病变治疗价值的临床研究[J].中国内镜杂志,2012,18(12):1245-1250.
[5]姚礼庆,钟芸诗,周平红.内镜黏膜下剥离术在早期胃癌治疗中的应用[J].中华胃肠外科杂志,2010,13(2):94-96.
[6]Oda I,Saito D,Tada M,et al.A multicenter retrospective study of endoscopic resection for early gastric cancer[J].Gastric Cancer,2006,9(4):262-270.
[7]Gotoda T,Yanagisawa A,Sasako M,et al.Incidence of lymph node metastasis from early gastric cancer:Estimation with a large number of cases at two large centers[J].Gastric Cancer,2000,3(4):219-225.
[8]Lee JH,Choi MG,Min BH,et al.Predictive factors for lymph node metastasis in patients with poorly differentiated early gastric cancer[J].Br J Surg,2012,99(12):1688-1692.
[9]Akamatsu T,Katsuyama T.Histochemical demonstration of mucins in the intramucosal laminated structure of human gastric signet ring cell carcinoma and its relation to submucosal invasion[J].Histochem J,1990,22(8):416-425.
[10]Kim KJ,Park SJ,Moon W,et al.Analysis of factors related to lymph node metastasis in undifferentiated early gastric cancer[J].Turk J Gastroenterol,2011,22(2):139-144.