直径≤2 cm胃癌的淋巴结转移与临床病理特征的关系
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Characteristics of gastric carcinomas of less than 2 cm in diameter associated with lymph node metastasis
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    目的:探讨肿瘤直径≤2 cm胃癌的淋巴结转移状况及其临床病理特征,为制定合理治疗方案提供依据-方法:对手术证实的453例肿瘤直径(最大径)≤2 cm的胃癌的临床病理资料进行回顾性分析,对患者年龄-性别-肿瘤组织学类型-形态学类型-大小-部位-浸润深度-脉管内癌栓等临床病理特征与淋巴结转移的关系进行单因素与多因素分析-结果:453例直径≤2 cm的胃癌中早期胃癌255例-进展期胃癌198例;淋巴结转移率分别为11.8%和46.0%(P=0.000 1);3.5%的早期胃癌与7.6%的进展期胃癌可见脉管内癌栓(P=0.034 1)-影响肿瘤直径≤2 cm的胃癌淋巴结转移的主要因素有肿瘤组织学类型-大小-浸润深度与脉管内癌栓等,Logistic回归分析显示肿瘤组织学类型-浸润深度与脉管内癌栓是肿瘤直径≤2 cm的胃癌淋巴结转移的独立危险因素-分层分析显示肿瘤大小-浸润深度与脉管内癌栓是直径≤2 cm的早期胃癌淋巴结转移的危险因素;而肿瘤组织学类型与浸润深度则是直径≤2 cm的进展期胃癌淋巴结转移的危险因素-结论:肿瘤直径≤2 cm的胃癌的淋巴结转移与肿瘤组织学类型-浸润深度及脉管内癌栓等因素有关-临床上应参考上述临床病理因素判断淋巴结转移风险,确定肿瘤直径≤2 cm的胃癌手术方案-

    Abstract:

    Objective:To investigate the clinicopathological characteristics of gastric carcinomas of less than 2 cm in diameter and situation of lymph node metastasis. Methods:The data from 453 patients surgically treated for gastric cancer less than 2 cm in diameter between 1998 and 2007 were reviewed retrospectively. The clinicopathological variables inculding age,gender,histological type,morpliologieal type,size,location,depth of invasion and tumor thrombus which were associated with lymph node metastasis,were evaluated. The results of retrospective analysis of clinicopathological data of 198 patients with advanced cancer were compared with those of 255 patients with early cancer. Univariate and multivariate analyses of the data were performed to evaluate the clinicopathological variables associated with lymph node metastasis. Results:A significant difference was observed on the tumor size(1.31 ± 0.57 cm vs 1.70 ± 0.47 cm,P < 0.0001),the incidence of lymph node metastasis(11.8% vs 46.0%,P=0.0001)and the presence of vascular or lymphatic invasion(3.5% vs 7.6%,P=0.0341)in the two groups. The histological classification,tumor size,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion showed a positive correlation with the rate of lymph node metastasis by univariate analysis. Multivariate analyses revealed that histological classification,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For early gastric cancer,tumor size,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion were the risk factors for lymph node metastasis. For advanced cancer,the histological classification and depth of gastric carcinoma infiltration were the risk factors for lymph node metastasis. Conclusion:Histological classification,depth of gastric carcinoma infiltration and presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in gastric cancer less than 2 cm in diameter. Minimal invasive treatment,such as laparoscopic gastrectomy,may be a possible treatment for highly selective patients.

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沈历宗,孙茂才,黄一鸣,朱正才,徐 皓,魏 尉,吴文溪.直径≤2 cm胃癌的淋巴结转移与临床病理特征的关系[J].南京医科大学学报(自然科学版),2009,29(7):1004-1008

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  • 收稿日期:2009-02-21
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