摘要目的 探讨进展期胃癌淋巴结转移(N分期)的影响因素及淋巴结清扫数目对患者预后的影响.方法 回顾性分析2011年全年于哈尔滨医科大学附属肿瘤医院行胃癌根治术的395例进展期胃癌患者的临床资料. Logistic回归分析N分期的影响因素,Cox回归模型分析预后影响因素, 并进一步针对不同N分期患者分析淋巴结清扫数目与患者生存的关系. 结果 全组有307例(77.7%)患者发生淋巴结转移,其中N0期88例,N1期86例,N2期111例,N3期110例. Borrmann分型(χ2= 32.045,P = 0.000)、组织类型(χ2= 5.595,P = 0.018)、浸润程度(χ2= 27.227,P = 0.000)和淋巴结清扫数目(χ2= 12.337,P= 0.000)是患者淋巴结转移的影响因素.全组患者3年总体生存率为65.3%. 肿瘤部位(OR = 2.86,95% CI:1.80 ~ 4.53,P = 0.000)、浸润程度(OR = 1.44,95% CI:1.12 ~ 1.85,P = 0.004)和淋巴结转移数目(OR = 1.58,95% CI:1.33 ~ 1.87,P = 0.000)是患者独立预后因素,而淋巴结清扫总数与预后无关(P>0.05).亚组分析显示,N3期清扫淋巴结数目≥40枚患者的3年总生存率明显高于N3期清扫不足40枚淋巴结的患者(χ2= 10.003,P = 0.019);而对于N0、N1和N2期,不同淋巴结清扫数的各组患者,3年总生存率间差异均无统计学意义(均P>0.05).结论 进展期胃癌N分期受Borrmann分型、组织类型、浸润程度和淋巴结清扫数目影响;对N0、N1、N2期进展期胃癌患者淋巴结清扫数达到20枚即可, 对N3期进展期胃癌淋巴结清扫数目达到40枚可改善患者预后.

abstractsObjective To investigative the influencing factors of metastatic lymph node staging (N staging), and the effect of number of lymph node dissection on the prognosis in advanced gastric carcinoma. Methods Clinicopathological data of 395 advanced gastric cancer patients undergoing radical operation in Harbin Medical University Cancer Hospital in 2011 were retrospectively analyzed. Logistic regression was used to investigate the influencing factors. Cox model was used to evaluate the prognostic factors. Association of survival with the number of lymph node dissection in different N stage was further examined. Results Lymph node metastasis was found in 307 patients (77.7%), including 88 of N0, 86 of N1, 111 of N2 and 110 of N3. Overall 3-year survival rate was 65.3%. Borrmann classification (χ2 = 32.045,P = 0.000), histopathological type (χ2 = 5.595,P = 0.018), depth of invasion (χ2= 27.227,P = 0.000) and the number of lymph node dissection (χ2= 12.337,P = 0.000) were influencing factors of metastatic lymph node. Tumor location (OR = 2.86,95% CI:1.80 ~ 4.53, P=0.000), depth of invasion(OR=1.44,95%CI:1.12~1.85,P=0.004) and the number of metastatic lymph node(OR = 1.58,95% CI:1.33 ~ 1.87,P = 0.000) were independent prognostic factors(all P < 0.05), and number of lymph node dissection was not associated with prognosis (P > 0.05). Subgroup analysis revealed overall survival rate of stage N3 patients with ≥ 40 of lymph node dissection was obviously higher as compared to those with < 40, while such difference was not found in N0, N1, N2 groups (all P>0.05). Conclusions Lymph node staging of advanced gastric cancer is associated with Borrmann classification, histopathological type, depth of invasion and number of lymph node dissection. Dissection of 20 lymph nodes is suitable for stage N0, N1 and N2, while ≥ 40 lymph nodes should be dissected in stage N3.