淋巴结转移阴性的胃癌患者临床病理特征及生存探讨

目的:探讨淋巴结转移阴性胃癌患者的临床病理特征以及预后影响因素。方法:收集2000年1月至2009年1月我院收治的胃癌患者325例,其中经病理检查显示淋巴结转移阴性的105例患者作为阴性组(LN-组),另229例阳性患者作为阳性组(LN+组),比较两组的临床病理特征及临床预后。结果:LN-组的肿瘤直径、浸润深度及术后化疗与LN+组比较差异显著(P0.05);LN-组的5年生存率为76.2%,显著高于LN+组的43.2%(P0.05)。未透浆膜的LN-患者3年、5年生存率显著高于浸透浆膜者,术后化疗的LN-患者5年生存率显著高于未化疗者(P0.05),肿瘤直径5 cm的LN-患者3、5年生存率显著高于≥5 cm者(P0.05)。单因素分析显示浸润深度、肿瘤大小及术后化疗与LN-胃癌患者的预后具有密切关系(P0.05)。COX多因素分析显示浸润深度是影响LN-胃癌患者临床预后的独立因素(P0.05)。结论:淋巴结转移阴性胃癌患者的病灶多位于中下部,男性多于女性,发病年龄多在60岁以内,肿瘤直径多不超过5 cm,浸润深度多未浸透浆膜,临床预后优于淋巴结转移阳性胃癌患者,浸润深度是影响淋巴结转移阴性胃癌患者临床预后的独立因素。

The Clinicopathological Features and Prognostic Factors of Patients with Node-negative Gastric Cancer

Objective:To investigate the clinicopathological features and prognostic factors in patients with node-negative gastric cancer.Methods:325 patients with gastric cancer in our hospital between January 2000 and January 2009 were collected, 105 cases with node-negative gastric cancer revealed by pathological examination as the negative group (LN-group), and the 229 cases of positive patients as the positive group (LN+group), the clinicopathological features and clinical outcomes of the two groups were compared.Results:The differences of tumor diameter, invasive depth and postoperative chemotherapy between LN-group and LN+ group were significant (P <0.05); the 5-year survival rate of LN-group was 76.2%, significantly higher than the 43.2% of LN+ group (P<0.05); The 3 and 5-year survival rates of LN-patients without infiltrating serosa were significantly higher than those of patients with infiltrating serosa. The 5-year survival rate of LN-patients with postoperative chemotherapy was significantly higher than patients without postoperative chemotherapy (P<0.05). The 3 and 5-year survival rates of LN-patients whose tumor diameter was less than 5 cm were significantly higher than those of patients whose tumor diameter was higher than 5 cm (P<0.05). Single factor analysis showed that the infiltrating depth, tumor size and postoperative chemotherapy were closely related to the prognosis of LN - patients with gastric cancer (P<0.05). Besides, the infiltrating depth was the independent factor for the prognosis of LN \- patients with gastric cancer (P<0.05).Conclusion:The lesions of lymph node metastasis of gastric cancer patients are mostly located in the middle -lower part and appear more in men and those elderly whose age is within 60 years old. Most tumor sizes are less than 5cm and LN-patients without infiltrating serosa are more common. Besides, the clinical prognosis in LN-patients is better than that in LN+ patients. The infiltrating depth is the independent factor for the prognosis of LNpatients with gastric cancer.