摘要目的 探讨pN1期胃癌淋巴结转移规律并分析淋巴结转移的危险因素.方法 回顾性分析2013年1月至2016年3月间在天津医科大学肿瘤医院接受根治性手术并经术后病理证实为pN1期(1~2枚淋巴结转移)胃癌的219例患者的临床病理资料,所有患者均为单发胃腺癌,术前未接受放化疗,均接受D2或D2+淋巴结清扫.统计各组淋巴结转移及跳跃转移的发生率,并分析其与患者临床病理因素的关系.结果 全组219例患者共清扫6440枚淋巴结,平均29.4(16~62)枚/例;阳性淋巴结319枚,淋巴结转移度为5.0%(319/6440);其中1枚淋巴结转移119例,2枚淋巴结转移100例.淋巴结转移率较高的淋巴结组别分别为No.3[29.2%(64/219)]、No.6[18.3%(40/219)]和No.4[11.4%(25/219)].与肿瘤直径≤5 cm者相比,肿瘤直径>5 cm者No.3组[39.4%(39/99)比20.8%(25/120),P=0.003]、No.4组[16.2%(16/99)比7.5%(9/120),P=0.045]和No.8组[16.2%(16/99)比6.7%(8/120),P=0.025]淋巴结转移率显著升高.全组患者发生淋巴结跳跃转移56例(25.6%),肿瘤直径>5 cm者淋巴结跳跃转移发生率显著升高[34.3%(34/99)比18.3%(22/120),P=0.007];多因素分析结果显示,肿瘤直径是pN1期胃癌淋巴结跳跃转移的独立危险因素(OR=1.982,95%CI:0.978~3.921,P=0.033).结论 pN1期胃癌淋巴结转移以胃旁第1站淋巴结为主,总体上遵循着由近及远的转移规律,但亦有相当数量的患者会出现淋巴结跳跃转移.肿瘤大小是影响各组淋巴结转移的重要因素,且肿瘤较大者更易发生淋巴结跳跃性转移.

abstractsObjective To investigate the lymph node metastasis pattern in pN1 stage gastric cancer patients and to analyze its risk factors . Methods Clinicopathological data of 219 patients who underwent radical gastrectomy and were confirmed as pN1 stage gastric cancer between January 2013 and March 2016 were reviewed. All the patients underwent D2 or extended D2 (D2+) lymphadenectomy. The overall metastatic rate was calculated. The risk factors associated with lymph node metastasis were analyzed. The pattern of skip lymph node metastasis and clinicopathological factors related to skip metastasis were analyzed. Results Among 219 patients, 119 patients had only one metastatic lymph node, and 100 patients had two metastatic lymph nodes. The relatively higher sites of lymph node metastasis were station No.3[29.2%(64/219)], No.6[18.3%(40/219)] and No.4[11.4% (25/219)]. Compared to patients with tumor diameter ≤5 cm, metastatic rates of station No.3 [39.4% (39/99) vs. 20.8%(25/120), P=0.003], No.4 [16.2%(16/99) vs. 7.5%(9/120), P=0.045] and No.8 [16.2%(16/99) vs. 6.7%(8/120), P=0.025] were significantly higher in those with tumor diameter > 5 cm. Skip lymph node metastasis was detected in 56 cases (25.6%) and skip lymph node metastatic rate was significantly higher in patients with tumor diameter > 5 cm [34.3%(34/99) vs. 18.3% (22/120), P=0.007]. Logistic regression analysis showed that the tumor size was an independent risk factor for the skip lymph node metastasis in pN1 stage gastric cancer (OR=1.982, 95%CI: 0.978 to 3.921, P=0.033). Conclusions The perigastric station No1 lymph node is the main site of early lymph node metastasis of pN1 stage gastric cancer. General pattern of lymph node metastasis is from proximus to distance, while quite a lot of skip lymph node metastases are observed. Tumor size is an important factor affecting the lymph node metastasis and bigger tumor may result in skip lymph node metastasis easily.