胃癌患者淋巴结转移危险因素分析及患者预后分析
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摘要
目的分析胃癌患者淋巴结转移的相关危险因素,以及对患者生存状况的影响。方法选取2014年3月至2016年3月收治的125例胃癌患者作为此次研究对象,对其进行回顾性分析,所有研究对象均经病理确诊行根治手术治疗。依照淋巴结是否转移进行分组,91例患者纳入未转移组,34例纳入转移组。将研究数据均纳入SPSS20. 0软件中进行整理分析,两组患者各临床指标的计数资料用"例"表示,行χ2检验,首先将P <0. 05各项指标进行Logistic单因素回归分析,得出淋巴结转移的危险因素,后进行Logistic多因素分析。以P <0. 05表示差异具有统计学意义。结果单因素分析结果显示:肿瘤病灶直径、分化程度、浸润深度、有无脉管侵犯以及有无神经侵犯等因素是淋巴结转移的危险因素(P <0. 05);多因素回归分析证实,肿瘤直径、肿瘤浸润深度、有无脉管侵犯以及有无神经侵犯是影响淋巴结转移的独立危险因素(P <0. 05);随访结果表明,发生淋巴结转移的患者2年生存率均明显低于未转移患者,差异有统计学意义(P <0. 05)。结论在胃癌患者中,肿瘤大小、脉管侵犯、神经侵犯以及肿瘤的浸润深度是胃癌患者淋巴结转移的独立危险因素,发生淋巴结转移患者其生存时间以及生存率均有明显降低,对患者的预后造成一定的影响和威胁。
Objective To study the risk factors of lymph node metastasis in patients with gastric cancer and to analyze its influence on the prognosis. Methods From March 2014 to March 2016,125 patients with gastric cancer were enrolled into this study. The retrospective analysis was performed. All the subjects were diagnosed by pathology and underwent radical surgery. 125 patients were divided into non-metastatic group( 91 cases) and metastatic group( 34 cases). The clinical data of patients were analyzed by using SPSS 20. 0 software. Count data were examined by using χ2test,Logistic regression were performed to analyze the risk factors of lymph node metastasis. A P value < 0. 05 was considered as statistically significant difference. Results Univariate analysis showed that the sex,age and location of tumor were not the risk factors of lymph node metastasis( P > 0. 05). The diameter,differentiation,depth of invasion,vascular invasion and nerve invasion were the risk factors of lymph node metastasis( P < 0. 05).Multivariate regression analysis showed that tumor diameter,depth of tumor invasion,vascular invasion and nerve invasion were independent risk factors for lymph node metastasis( P < 0. 05). The results of follow-up showed that the 2-year survival rate of the patients with lymph node metastasis was significantly lower than that of the patients without metastasis,with significant difference( P < 0. 05). Conclusion In patients with gastric cancer, tumor size, vascular invasion, nerve invasion and depth of tumor invasion are independent risk factors for lymph node metastasis. The survival time and survival rate of patients with lymph node metastasis are significantly decreased,which has a certain influence and threat to the prognosis.
Objective To study the risk factors of lymph node metastasis in patients with gastric cancer and to analyze its influence on the prognosis. Methods From March 2014 to March 2016,125 patients with gastric cancer were enrolled into this study. The retrospective analysis was performed. All the subjects were diagnosed by pathology and underwent radical surgery. 125 patients were divided into non-metastatic group( 91 cases) and metastatic group( 34 cases). The clinical data of patients were analyzed by using SPSS 20. 0 software. Count data were examined by using χ2test,Logistic regression were performed to analyze the risk factors of lymph node metastasis. A P value < 0. 05 was considered as statistically significant difference. Results Univariate analysis showed that the sex,age and location of tumor were not the risk factors of lymph node metastasis( P > 0. 05). The diameter,differentiation,depth of invasion,vascular invasion and nerve invasion were the risk factors of lymph node metastasis( P < 0. 05).Multivariate regression analysis showed that tumor diameter,depth of tumor invasion,vascular invasion and nerve invasion were independent risk factors for lymph node metastasis( P < 0. 05). The results of follow-up showed that the 2-year survival rate of the patients with lymph node metastasis was significantly lower than that of the patients without metastasis,with significant difference( P < 0. 05). Conclusion In patients with gastric cancer, tumor size, vascular invasion, nerve invasion and depth of tumor invasion are independent risk factors for lymph node metastasis. The survival time and survival rate of patients with lymph node metastasis are significantly decreased,which has a certain influence and threat to the prognosis.
引文
[1]李子禹,高翔宇,贾永宁.试析腹腔镜胃癌根治术淋巴结清扫的相关问题[J/CD].中华普外科手术学杂志(电子版),2018,12(2):99-102.
[2]胡祥.胃癌腹主动脉周围淋巴结廓清的变迁及现状[J/CD].中华普外科手术学杂志(电子版),2017,11(6):451-456.
[3]余佩武,罗华星.达芬奇机器人在胃肠手术中的应用与发展[J/CD].中华普外科手术学杂志(电子版),2017,11(1):1-4.
[4]陈港心,孙振强,王海江.中上部胃癌第10组淋巴结转移影响因素及预后意义[J].中华肿瘤防治杂志,2016,23(8):530-534.
[5]陈路川,魏晟宏,叶再生,等.进展期胃癌No. 8p淋巴结转移的危险因素及预后分析[J].中华胃肠外科杂志,2017,20(2):218-223.
[6]权峰涛,杨维桢.淋巴结转移率在评估胃癌患者预后中的价值[J].中国临床研究,2017,30(6):804-806.
[7]黎焕君,刘琦,陈志良,等.淋巴结转移率对胃癌D2根治术患者的预后分析[J].肿瘤学杂志,2016,22(4):300-304.
[8]禚春杨,薛英威,郭忠武,等.进展期胃癌淋巴结分期的影响因素及临床意义[J].中华胃肠外科杂志,2016,19(1):62-66.
[9]邹振玉,沈笛,邢晓伟,等.早期胃癌淋巴结转移相关因素和淋巴结清扫范围的探讨[J].中华普通外科杂志,2016,31(6):456-459.
[10]龚玉竹,庞学利,杨松柏,等.淋巴结转移阴性的胃癌患者临床病理特征及生存探讨[J].现代生物医学进展,2016,16(3):466-469.
[11]骆彩冰,张冠荣,王玮,等.三种淋巴结分期方案对胃癌根治术后患者预后评估价值的对比分析[J].中华胃肠外科杂志,2016,19(10):1107-1112.
[12] Son T,Kwon IG,Lee JH,et al. Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer[J]. Oncotarget,2017,8(48):84515-84528.
[13] Pereira MA,Ramos MFKP,Dias AR,et al. Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment[J]. Journal of Gastrointestinal Surgery,2018,22(1):23-31.
[14]陈元岩,陈显国,李天翔,等.进展期胃癌淋巴结转移规律与清扫范围对临床结局的影响[J].广东医学,2016,37(24):3693-3695.
[15]陆恒,李楠,叶院宁,等.早期胃癌淋巴结转移的危险因素:339例外科手术病例的回顾性分析[J].胃肠病学和肝病学杂志,2016,25(6):617-619.
[2]胡祥.胃癌腹主动脉周围淋巴结廓清的变迁及现状[J/CD].中华普外科手术学杂志(电子版),2017,11(6):451-456.
[3]余佩武,罗华星.达芬奇机器人在胃肠手术中的应用与发展[J/CD].中华普外科手术学杂志(电子版),2017,11(1):1-4.
[4]陈港心,孙振强,王海江.中上部胃癌第10组淋巴结转移影响因素及预后意义[J].中华肿瘤防治杂志,2016,23(8):530-534.
[5]陈路川,魏晟宏,叶再生,等.进展期胃癌No. 8p淋巴结转移的危险因素及预后分析[J].中华胃肠外科杂志,2017,20(2):218-223.
[6]权峰涛,杨维桢.淋巴结转移率在评估胃癌患者预后中的价值[J].中国临床研究,2017,30(6):804-806.
[7]黎焕君,刘琦,陈志良,等.淋巴结转移率对胃癌D2根治术患者的预后分析[J].肿瘤学杂志,2016,22(4):300-304.
[8]禚春杨,薛英威,郭忠武,等.进展期胃癌淋巴结分期的影响因素及临床意义[J].中华胃肠外科杂志,2016,19(1):62-66.
[9]邹振玉,沈笛,邢晓伟,等.早期胃癌淋巴结转移相关因素和淋巴结清扫范围的探讨[J].中华普通外科杂志,2016,31(6):456-459.
[10]龚玉竹,庞学利,杨松柏,等.淋巴结转移阴性的胃癌患者临床病理特征及生存探讨[J].现代生物医学进展,2016,16(3):466-469.
[11]骆彩冰,张冠荣,王玮,等.三种淋巴结分期方案对胃癌根治术后患者预后评估价值的对比分析[J].中华胃肠外科杂志,2016,19(10):1107-1112.
[12] Son T,Kwon IG,Lee JH,et al. Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer[J]. Oncotarget,2017,8(48):84515-84528.
[13] Pereira MA,Ramos MFKP,Dias AR,et al. Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment[J]. Journal of Gastrointestinal Surgery,2018,22(1):23-31.
[14]陈元岩,陈显国,李天翔,等.进展期胃癌淋巴结转移规律与清扫范围对临床结局的影响[J].广东医学,2016,37(24):3693-3695.
[15]陆恒,李楠,叶院宁,等.早期胃癌淋巴结转移的危险因素:339例外科手术病例的回顾性分析[J].胃肠病学和肝病学杂志,2016,25(6):617-619.