摘要目的 探讨影响进展期胃癌第14v组淋巴结转移的危险因素.方法 回顾性分析2007年1月至2011年12月天津医科大学肿瘤医院收治的170例进展期胃癌患者的临床资料.所有患者行胃癌D2+第14v组淋巴结清扫手术治疗,并经病理检查确诊为腺癌.记录患者的一般资料,收集手术切除标本详细记录各组淋巴结检出数目及阳性数目.影响第14v组淋巴结转移的临床病理因素的单因素分析及多因素分析采用二元Logistic回归模型,第14v组淋巴结转移与区域淋巴结转移相关性分析采用二元Logistic回归分析.结果 170例患者共获取第14v组淋巴结459枚,平均每例患者2.7枚(1～ 17枚)；共检出阳性淋巴结55枚,平均每例患者1.7枚(1～3枚).单因素分析结果显示:第14v组淋巴结转移与肿瘤根治程度、肿瘤直径、肿瘤淋巴结转移(N分期)、肿瘤远处转移(M分期)相关.进一步分析发现:肿瘤R0切除、肿瘤直径≤4 cm、N0期、M0期的进展期胃癌患者比较,肿瘤R1或R2切除、肿瘤直径＞4 cm、N2期、N3期、M1期的患者更易发生第14v组淋巴结转移(OR=3.899,2.646,19.231,33.929,5.000,95％可信区间:1.111～13.677,1.075 ～ 6.516,2.333 ～ 158.548,4.310 ～ 267.112,1.617 ～ 15.464,P＜0.05).多因素分析结果显示:N分期是影响进展期胃癌患者第14v组淋巴结转移的独立危险因素,与N0期患者比较,N2、N3期患者更容易发生第14v组淋巴结转移(OR=15.248,26.287,95％可信区间:1.811 ～128.386,3.244～213.034,P ＜0.05).区域淋巴结转移与第14v组淋巴结转移的相关分析结果表明:第4sb、4d、5、6、7、8a、9、11p、12a、16组淋巴结转移与第14v组淋巴结转移相关(OR=3.923,3.335,2.693,5.641,3.100,4.203,3.655,3.660,3.838,17.400,95％可信区间:1.264～12.177,1.425 ～7.807,1.149 ～6.312,2.126 ～ 14.965,1.311～7.330,1.735～ 10.185,1.395 ～9.582,1.331 ～ 10.666,1.086～ 13.571,2.707 ～ 111.837,P ＜0.05).结论 N分期是第14v组淋巴结转移的独立危险因素,上游淋巴结中第6组淋巴结状态是预测第14v组淋巴结转移的最佳淋巴结指标.

abstractsObjective To investigate the risk factors for group 14v lymph node metastasis in advanced gastric cancer.Methods The clinical data of 170 patients with advanced gastric cancer who were admitted to the Tianjin Cancer Hospital from January 2007 to December 2011 were retrospectively analyzed.All the patients received D2 gastrectomy + group 14v lymph node dissection.All the patients were with gastric adenocarcinoma.The general information of the patients,and the number of lymph node dissected and lymph node with positive expression were recorded.Univariate and multivariate analysis of clinicopathological factors influencing the group 14v lymph node metastasis were done using bivariate Logistic regression model.The correlation between the group 14v lymph node metastasis and regional lymph node metastasis was analyzed using the bivariate Logistic regression analysis.Results Of the 170 patients,459 group 14v lymph nodes were dissected,and 2.7 lymph nodes for each patient (range,1-17 lymph nodes) ; 55 positive lymph nodes were detected in patients with group 14v lymph node metastasis,and 1.7 lymph nodes for each patient (range,1-3 lymph nodes).The results of univariate analysis showed that group 14v lymph node metastasis was correlated with the degree of radical dissection of tumor,diameter of the tumor,lymph node metastasis (N stage) and distal metastasis (M stage).Compared with patients with advanced gastric cancer and with R0 resection of tumor,tumor diameter≤4 cm,N0 stages,and M0 stages,patients with R1 or R2 resection,tumor diameter ＞4 cm,N2 stages,N3 stages,and M1 stages had higher risk of group 14v lymph node metastasis (OR =3.899,2.646,19.231,33.929,5.000,95％ confidence interval:1.11113.677,1.075-6.516,2.333-158.548,4.310-267.112,1.617-15.464,P ＜ 0.05).The resnlts of multivariate analysis showed that N stage was the independent risk factor influencing the group 14v lymph node metastasis.Compared with patients in N0 stage,patients in N2 or N3 stage had higher risk of group 14v lymph node metastasis (OR =15.248,26.287,95％ confidence interval:1.811-128.386,3.244-213.034,P ＜ 0.05).Group 4sb,4d,5,6,7,8a,9,11p,12a and 16 lymph node mnetastasis were coxelated with group 14v lymph node metastasis (OR =3.923,3.335,2.693,5.641,3.100,4.203,3.655,3.660,3.838,17.400,95％ confidence interval:1.264-12.177,1.425-7.807,1.149-6.312,2.126-14.965,1.311-7.330,1.735-10.185,1.395-9.582,1.331-10.666,1.086-13.571,2.707-111.837,P ＜0.05).Conclusion N stage is an independent risk factor of group 14v lymph node metastasis,and the status of group 6 lymph node is the best indicator for group 14v lymph node metastasis.