胃癌浸润深度、淋巴结转移及预后关系的研究
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摘要
目的:对胃癌浸润深度、淋巴结转移及预后三者关系进行研究,为临床进行合理的淋巴结清扫范围及手术方式的合理选择提供一定参考依据。
方法:回顾性分析1998年9月至2004年9月行胃癌根治性切除手术的122例胃癌患者的病例资料,统计胃癌浸润深度、淋巴结转移情况并随访预后情况,分析三者之间的关系。
结果:临床病理资料根据2002年日本肿瘤协会公布的JGC-TNM分期标准,胃癌浸润深度在T_1、T_2、T_3和T_4时的淋巴结转移率分别为5.0%、47.8%、71.0%和100%,各组比较差异有统计学意义(P＜0.01),依次呈递增趋势。T_1、T_2、T_3和T_4患者的3年生存率分别为85.0%、34.8%、24.6%和0,各组比较差异有统计学意义(P＜0.01)。N_0、N_1、N_2和N_3患者的3年生存率分别为84.3%、69.2%、30.0%和11.1%,各组比较差异有统计学意义(P＜0.01)。
结论:胃癌的淋巴结转移与浸润深度相关,而胃癌的浸润深度及淋巴结转移与预后相关,患者的3年生存率随淋巴结转移站次的增加及浸润深度加深而下降。
Objective:To investigate the relationship among the depth of invasion, lymph node metastasis and prognosis of gastric cancer so as to offer basis for dissecting appropriate extent of the lymph node and to choose reasonable operation.
Methods:A retrospective analysis was done on 122 cases with gastric cancer undergone curative gastrectomy from September 1998 to September 2004 to study relationship among the depth of invasion,lymph node metastasis and prognosis of gastric cancer.
Results:The lymph node metastasis rates at depth of invasion of T_1,T_2,T_3 and T_4 cases were 5.0%,47.8%,71.0%and 100%respectively,with statistically significant difference(P＜0.01).The 3-year survival rate of T_1,T_2,T_3 and T_4 cases were 85.0%,34.8%,24.6%and 0 respectively,with statistically significant difference(P＜0.01).The 3-year survival rate in N_0,N_1,N_2 and N_3 cases were 84.3%,69.2%,30.0%and 11.1%respectively,with statistically significant difference(P＜0.01).
Conclusions:The depth of invasion and are correlated with the lymph node metastasis.The depth of invasion and the lymph node metastasis are related to the prognosis of gastric cancer and the 3-year survival rate of the cases makes a sharp descent with the increasing of lymph node metastasis and depth of invasion.
方法:回顾性分析1998年9月至2004年9月行胃癌根治性切除手术的122例胃癌患者的病例资料,统计胃癌浸润深度、淋巴结转移情况并随访预后情况,分析三者之间的关系。
结果:临床病理资料根据2002年日本肿瘤协会公布的JGC-TNM分期标准,胃癌浸润深度在T_1、T_2、T_3和T_4时的淋巴结转移率分别为5.0%、47.8%、71.0%和100%,各组比较差异有统计学意义(P＜0.01),依次呈递增趋势。T_1、T_2、T_3和T_4患者的3年生存率分别为85.0%、34.8%、24.6%和0,各组比较差异有统计学意义(P＜0.01)。N_0、N_1、N_2和N_3患者的3年生存率分别为84.3%、69.2%、30.0%和11.1%,各组比较差异有统计学意义(P＜0.01)。
结论:胃癌的淋巴结转移与浸润深度相关,而胃癌的浸润深度及淋巴结转移与预后相关,患者的3年生存率随淋巴结转移站次的增加及浸润深度加深而下降。
Objective:To investigate the relationship among the depth of invasion, lymph node metastasis and prognosis of gastric cancer so as to offer basis for dissecting appropriate extent of the lymph node and to choose reasonable operation.
Methods:A retrospective analysis was done on 122 cases with gastric cancer undergone curative gastrectomy from September 1998 to September 2004 to study relationship among the depth of invasion,lymph node metastasis and prognosis of gastric cancer.
Results:The lymph node metastasis rates at depth of invasion of T_1,T_2,T_3 and T_4 cases were 5.0%,47.8%,71.0%and 100%respectively,with statistically significant difference(P＜0.01).The 3-year survival rate of T_1,T_2,T_3 and T_4 cases were 85.0%,34.8%,24.6%and 0 respectively,with statistically significant difference(P＜0.01).The 3-year survival rate in N_0,N_1,N_2 and N_3 cases were 84.3%,69.2%,30.0%and 11.1%respectively,with statistically significant difference(P＜0.01).
Conclusions:The depth of invasion and are correlated with the lymph node metastasis.The depth of invasion and the lymph node metastasis are related to the prognosis of gastric cancer and the 3-year survival rate of the cases makes a sharp descent with the increasing of lymph node metastasis and depth of invasion.
引文
[1]丁永斌,陈国玉,夏建国,等.胃癌淋巴结转移个数与胃癌预后关系分析.中国实用外科杂志,2000,20(11):666-667.
[2]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007.
[3]詹文华.淋巴结清扫手术治疗胃癌的现状.中国实用外科杂志.1999,19:120-121.
[4]车向明,王康,帆北修一,进展期胃癌组织学类型与胃癌预后的关系.中华普通外科杂志,2000,6(15):364-366.
[5]Lipham JC,DeMeester TR.Preoperative diagnosis of lymph node metastasis:a dream? Gastric Cancer 2006,9(2):70-71.
[6]Hicks S.Gastric cancer:diagnosis,risk factors,treatment and life issues.Br J Nurs 2001,10(8):529-536.
[7]冯润华,朱正纲,燕敏,等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值。中华胃肠外科杂志,2007,10(5):431-435.
[8]Shimoyama S,Seto Y,Yasuda H,et al.Concepts,rationale,and current outcomes of less invasive surgical strategies for early gastric cancer:data from a quarter-century of experience in a single institution.World J Surg 2005,29(1):58-65.
[9]秦环龙,林超鸿.胃癌临床病理特征与淋巴转移关系研究.中国实用外科杂志,2001,21(7):645-648
[10]Al-Moundhri MS,Al-Bahrani B,Burney IA et al.The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients.Ontology,2006,70(2):90-96.
[11]王振宁,徐惠绵,王舒宝,等.胃癌新TNM分期与其生物学行及预后的关系.中华外科杂志,2000,7(38):
[12]Lee CC,Wu CW,Lo SS et al.Survival predictors in patients with node-negative gastric carcinoma.J Gastroenterol Hepatol 2007;22(7):1014-1018.
[13]Boric F,Millat B,Fingerhut A,Hay JM,Fagniez PL,De SB.Lymphatic involvement in early gastric cancer:prevalence and prognosis in France.Arch Surg 2000,135(10):1218-1223.
[14]Kunisaki C,Shimada H,Nomura M et al.Therapeutic strategy for patients with pN0 gastric carcinoma.J Surg Oncol 2006,94(3):212-219.
[15]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007,104(3):234-236.
[16]Marchet A,Mocellin S,Ambrosi A et al.The ratio between metastatic and examined lymph nodes(N ratio)is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy:results from an Italian multicentric study in 1853 patients.Ann Surg 2007,245(4):543-552.
[17]丁永斌,刘月仙,陈国玉.胃癌癌周淋巴结转移状况与胃癌预后关系.中国现代普通外科进展.2001,4(1):37-39
[18]von KG.[Documentation--classification of nursing procedures].Tidsskr Sykepl,1997,85(14):56-60.
[19]Katai H,Yoshimura K,Maruyama K,Sasako M,Sano T.Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma.Cancer,2000,88(8):1796-1800.
[20]梁雨荣,赵涛,何尔斯泰.基质金属蛋白酶MMPs和MMP2与胃癌转 移的关系[J].中华普通外科杂志,2000,15(2):119
[21]Yokota T,Ishiyama S,Saito T et al.Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 2002,22(6B):3673-3677.
[22]李英男.胃癌预后影响因素的研究进展.现代肿瘤医学,2007,4(15):567-569.
[23]Kunisaki C,Akiyama H,Nomura M et al.Lymph node status in patients with submucosal gastric cancer.Ann Surg Oncol 2006,13(11):1364-1371.
[24]Tatsumi Y,Tanigawa N,Nishimura H et al.Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10.Gastric Cancer 2006,9(2):120-128.
[1]Sobin LH,Fleming ID.TNM Classification of Malignant Tumors,fifth edition(1997).Union Internationale Contre le Cancer and the American Joint Committee on Cancer.Cancer 1997;80(9):1803-1804.
[2]Cheong JH,Hyung WJ,Shen JG et al.The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer.Ann Surg Oncol 2006;13(3):377-385.
[3]日本胃癌研究会.胃癌取极ぃ规约,东京.金元:(12版)1993,5-9。
[4]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007;104(3):234-236.
[5]车向明,王康,帆北修一,进展期胃癌组织学类型与胃癌预后的关系.中华普通外科杂志,2000,6(15):364-366.
[6]Liu CG,Lu P,Lu Y et al.Distribution of solitary lymph nodes in primary gastric cancer:a retrospective study and clinical implications.World J Gastroenterol 2007;13(35):4776-4780.
[7]秦环龙,林超鸿.胃癌临床病理特征与淋巴转移关系研究.中国实用外科杂志,2001,21(7):645-648.
[8]Al-Moundhri MS,Al-Bahrani B,Burney IA et al.The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients.Oncology 2006;70(2):90-96.
[9]Kunisaki C,Shimada H,Nomura M et al.Therapeutic strategy for patients with pN0 gastric carcinoma.J Surg Oncol,2006;94(3):212-219.
[10]王振宁,徐惠绵,王舒宝等.胃癌新TNM分期与其生物学行为及预后的 关系.中华外科杂志,2000,7(38):493-495.
[11]Borie F,Millat B,Fingerhut A,et al.Lymphatic involvement in early gastric cancer:prevalence and prognosis in France.Arch Surg 2000;135(10):1218-1223.
[12]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007;104(3):234-236.
[13]Marchet A,Mocellin S,Ambrosi A et al.The ratio between metastatic and examined lymph nodes(N ratio)is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy:results from an Italian multicentric study in 1853 patients.Ann Surg 2007;245(4):543-552.
[14]Katai H,Yoshimura K,Maruyama K,et al.Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma.Cancer 2000;88(8):1796-1800.
[15]Lipham JC,DeMeester TR.Preoperative diagnosis of lymph node metastasis:a dream? Gastric Cancer 2006;9(2):70-71.
[16]Hicks S.Gastric cancer:diagnosis,risk factors,treatment and life issues.Br J Nurs 2001;10(8):529-536.
[17]冯润华,朱正纲,燕敏等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值.中华胃肠外科杂志,2007;10(5):431-435.
[18]Shen JY,Kim S,Cheong JH et al.The impact of total retrieved lymph nodes on staging and survival of patients with pT3 gastric cancer.Cancer 2007;110(4):745-751.
[19]Shiraishi N,Inomata M,Osawa N,et al.Early and late recurrence after gastrectomy for gastric carcinoma.Univariate and multivariate analyses.Cancer 2000;89(2):255-261.
[21]Layke JC,Lopez PP.Gastric cancer:diagnosis and treatment options.Am Fam Physician 2004;69(5):1133-1140.
[22]Yokota T,Ishiyama S,Saito T et al.Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 2002;22(6B):3673-3677.
[23]Kakeji Y,Maehara Y,Tomoda M et al.Long-term survival of patients with stage Ⅳ gastric carcinoma.Cancer,1998;82(12):2307-2311.
[24]李英男.胃癌预后影响因素的研究进展.现代肿瘤医学,2007:4(15):567-569.
[25]Aznavoorian S,Murphy AN,Stetler-Stevenson WG,et al.Molecular aspects of tumor cell invasion and metastasis.Cancer 1993;71(4):1368-1383.
[26]茹国庆,赵仲生,汤琪乐等.Syndecan-1和乙酰肝素酶mRNA表达与胃癌转移和预后的关系.中华外科杂志,2006:44(15):1062-1064
[2]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007.
[3]詹文华.淋巴结清扫手术治疗胃癌的现状.中国实用外科杂志.1999,19:120-121.
[4]车向明,王康,帆北修一,进展期胃癌组织学类型与胃癌预后的关系.中华普通外科杂志,2000,6(15):364-366.
[5]Lipham JC,DeMeester TR.Preoperative diagnosis of lymph node metastasis:a dream? Gastric Cancer 2006,9(2):70-71.
[6]Hicks S.Gastric cancer:diagnosis,risk factors,treatment and life issues.Br J Nurs 2001,10(8):529-536.
[7]冯润华,朱正纲,燕敏,等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值。中华胃肠外科杂志,2007,10(5):431-435.
[8]Shimoyama S,Seto Y,Yasuda H,et al.Concepts,rationale,and current outcomes of less invasive surgical strategies for early gastric cancer:data from a quarter-century of experience in a single institution.World J Surg 2005,29(1):58-65.
[9]秦环龙,林超鸿.胃癌临床病理特征与淋巴转移关系研究.中国实用外科杂志,2001,21(7):645-648
[10]Al-Moundhri MS,Al-Bahrani B,Burney IA et al.The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients.Ontology,2006,70(2):90-96.
[11]王振宁,徐惠绵,王舒宝,等.胃癌新TNM分期与其生物学行及预后的关系.中华外科杂志,2000,7(38):
[12]Lee CC,Wu CW,Lo SS et al.Survival predictors in patients with node-negative gastric carcinoma.J Gastroenterol Hepatol 2007;22(7):1014-1018.
[13]Boric F,Millat B,Fingerhut A,Hay JM,Fagniez PL,De SB.Lymphatic involvement in early gastric cancer:prevalence and prognosis in France.Arch Surg 2000,135(10):1218-1223.
[14]Kunisaki C,Shimada H,Nomura M et al.Therapeutic strategy for patients with pN0 gastric carcinoma.J Surg Oncol 2006,94(3):212-219.
[15]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007,104(3):234-236.
[16]Marchet A,Mocellin S,Ambrosi A et al.The ratio between metastatic and examined lymph nodes(N ratio)is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy:results from an Italian multicentric study in 1853 patients.Ann Surg 2007,245(4):543-552.
[17]丁永斌,刘月仙,陈国玉.胃癌癌周淋巴结转移状况与胃癌预后关系.中国现代普通外科进展.2001,4(1):37-39
[18]von KG.[Documentation--classification of nursing procedures].Tidsskr Sykepl,1997,85(14):56-60.
[19]Katai H,Yoshimura K,Maruyama K,Sasako M,Sano T.Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma.Cancer,2000,88(8):1796-1800.
[20]梁雨荣,赵涛,何尔斯泰.基质金属蛋白酶MMPs和MMP2与胃癌转 移的关系[J].中华普通外科杂志,2000,15(2):119
[21]Yokota T,Ishiyama S,Saito T et al.Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 2002,22(6B):3673-3677.
[22]李英男.胃癌预后影响因素的研究进展.现代肿瘤医学,2007,4(15):567-569.
[23]Kunisaki C,Akiyama H,Nomura M et al.Lymph node status in patients with submucosal gastric cancer.Ann Surg Oncol 2006,13(11):1364-1371.
[24]Tatsumi Y,Tanigawa N,Nishimura H et al.Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10.Gastric Cancer 2006,9(2):120-128.
[1]Sobin LH,Fleming ID.TNM Classification of Malignant Tumors,fifth edition(1997).Union Internationale Contre le Cancer and the American Joint Committee on Cancer.Cancer 1997;80(9):1803-1804.
[2]Cheong JH,Hyung WJ,Shen JG et al.The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer.Ann Surg Oncol 2006;13(3):377-385.
[3]日本胃癌研究会.胃癌取极ぃ规约,东京.金元:(12版)1993,5-9。
[4]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007;104(3):234-236.
[5]车向明,王康,帆北修一,进展期胃癌组织学类型与胃癌预后的关系.中华普通外科杂志,2000,6(15):364-366.
[6]Liu CG,Lu P,Lu Y et al.Distribution of solitary lymph nodes in primary gastric cancer:a retrospective study and clinical implications.World J Gastroenterol 2007;13(35):4776-4780.
[7]秦环龙,林超鸿.胃癌临床病理特征与淋巴转移关系研究.中国实用外科杂志,2001,21(7):645-648.
[8]Al-Moundhri MS,Al-Bahrani B,Burney IA et al.The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients.Oncology 2006;70(2):90-96.
[9]Kunisaki C,Shimada H,Nomura M et al.Therapeutic strategy for patients with pN0 gastric carcinoma.J Surg Oncol,2006;94(3):212-219.
[10]王振宁,徐惠绵,王舒宝等.胃癌新TNM分期与其生物学行为及预后的 关系.中华外科杂志,2000,7(38):493-495.
[11]Borie F,Millat B,Fingerhut A,et al.Lymphatic involvement in early gastric cancer:prevalence and prognosis in France.Arch Surg 2000;135(10):1218-1223.
[12]Saito H,Fukumoto Y,Osaki T et al.Prognostic significance of the ratio between metastatic and dissected lymph nodes(n ratio)in patients with advanced gastric cancer.J Surg Oncol 2007;104(3):234-236.
[13]Marchet A,Mocellin S,Ambrosi A et al.The ratio between metastatic and examined lymph nodes(N ratio)is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy:results from an Italian multicentric study in 1853 patients.Ann Surg 2007;245(4):543-552.
[14]Katai H,Yoshimura K,Maruyama K,et al.Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma.Cancer 2000;88(8):1796-1800.
[15]Lipham JC,DeMeester TR.Preoperative diagnosis of lymph node metastasis:a dream? Gastric Cancer 2006;9(2):70-71.
[16]Hicks S.Gastric cancer:diagnosis,risk factors,treatment and life issues.Br J Nurs 2001;10(8):529-536.
[17]冯润华,朱正纲,燕敏等.淋巴结转移率对T2-T3期胃癌患者预后评估的价值.中华胃肠外科杂志,2007;10(5):431-435.
[18]Shen JY,Kim S,Cheong JH et al.The impact of total retrieved lymph nodes on staging and survival of patients with pT3 gastric cancer.Cancer 2007;110(4):745-751.
[19]Shiraishi N,Inomata M,Osawa N,et al.Early and late recurrence after gastrectomy for gastric carcinoma.Univariate and multivariate analyses.Cancer 2000;89(2):255-261.
[21]Layke JC,Lopez PP.Gastric cancer:diagnosis and treatment options.Am Fam Physician 2004;69(5):1133-1140.
[22]Yokota T,Ishiyama S,Saito T et al.Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Res 2002;22(6B):3673-3677.
[23]Kakeji Y,Maehara Y,Tomoda M et al.Long-term survival of patients with stage Ⅳ gastric carcinoma.Cancer,1998;82(12):2307-2311.
[24]李英男.胃癌预后影响因素的研究进展.现代肿瘤医学,2007:4(15):567-569.
[25]Aznavoorian S,Murphy AN,Stetler-Stevenson WG,et al.Molecular aspects of tumor cell invasion and metastasis.Cancer 1993;71(4):1368-1383.
[26]茹国庆,赵仲生,汤琪乐等.Syndecan-1和乙酰肝素酶mRNA表达与胃癌转移和预后的关系.中华外科杂志,2006:44(15):1062-1064