Page 51 - 南京医科大学自然版

第45卷第5期 南京医科大学学报（自然科学版）
2025年5月 Journal of Nanjing Medical University（Natural Sciences） ·637 ·

·临床研究·

优化淋巴结比率预测淋巴结转移阳性胃癌患者预后研究

张嘉男，李沣员，李清雅，王林俊，张殿彩，王国梁，杨 力，徐泽宽，徐 皓 *
南京医科大学第一附属医院普外科，江苏 南京 210029

［摘 要］ 目的：将淋巴结比率（lymph node ratio，LNR）与中心淋巴结（central lymph node，CnLN）转移结合，构建优化淋巴结比
率（modified lymph node ratio，mLNR），并探究该指标对胃癌患者预后的影响。方法：卡方检验分析对比CnLN有无转移两组胃
癌患者组间差异，Cox回归分析影响胃癌患者生存的因素，构建受试者工作特征（receiver operating characteristic，ROC）曲线以
确定LNR高低分类截断值，绘制Kaplan⁃Meier曲线可视化分析胃癌患者生存情况，构建列线图以预测胃癌患者生存预后。结
果：胃切除方式（P=0.042）、肿瘤大小（P=0.043）、分化程度（P=0.001）、脉管侵犯（P < 0.001）、神经侵犯（P < 0.001）、T 分期（P=
0.001）、N 分期（P < 0.001）、癌胚抗原（carcinoembryonic antigen，CEA）（P=0.002）及糖类抗原 199（carbohydrate antigen199，
CA199）（P=0.026）在CnLN有无转移两组间差异有统计学意义；LNR及CnLN均能很好区分胃癌患者生存情况，但LNR的区分
效力显著强于CnLN。此外mLNR能够很好地预测胃癌患者生存，是影响胃癌患者生存的独立危险因素。结论：利用CnLN构
建的mLNR是影响胃癌患者生存的独立危险因素，有望作为胃癌患者预后判别的新指标。
［关键词］ 胃癌；淋巴结比率；中心淋巴结；列线图
［中图分类号］ R735.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）05⁃637⁃08
doi：10.7655/NYDXBNSN241322

Prediction of prognosis in patients with node ⁃ positive gastric cancer by modified lymph

node ratio
ZHANG Jia’nan ，LI Fengyuan ，LI Qingya ，WANG Linjun ，ZHANG Diancai ，WANG Guoliang ，YANG Li ，
XU Zekuan，XU Hao *
Department of General Surgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To construct a modified lymph node ratio（mLNR）by combining the lymph node ratio（LNR）with central
lymph node（CnLN）metastasis，and to investigate the impact of this indicator on the prognosis of gastric cancer patients. Methods：Chi⁃
square analysis was performed to compare the differences between groups of gastric cancer patients with and without CnLN metastasis.
Cox regression analysis was performed to identify factors affecting the survival of gastric cancer patients，receiver operating
characteristic（ROC）curve was constructed to determine the cut⁃off value of LNR classification. Kaplan⁃Meier curve was drawn to
visualize the survival of gastric cancer patients，and a nomogram was constructed to predict the survival prognosis of gastric cancer
patients. Results：Type of gastrectomy（P=0.042），tumor size（P=0.043），degree of differentiation（P=0.001），vascular invasion（P <
0.001），neural invasion（P < 0.001），T stage（P=0.001），N stage（P < 0.001），carcinoembryonic antigen（CEA）（P=0.002），and
carbohydrate antigen 199（CA199）（P=0.026）were significantly different between the two groups. Both LNR and CnLNs were able to
distinguish the survival of gastric cancer patients，but the distinguishing power of LNR was significantly stronger than that of CnLN. In
addition，mLNR could effectively predict the survival of patients with gastric cancer and was identified as an independent risk factor
affecting their survival. Conclusion：mLNR，constructed using CnLN，is an independent risk factor affecting the survival of gastric
cancer patients and has the potential to serve as a new indicator for prognosis discrimination in gastric cancer patients.
［Key words］ gastric cancer；lymph node ratio；central lymph node；nomogram
［J Nanjing Med Univ，2025，45（05）：637⁃643，651］

［基金项目］ 国家自然科学基金（82373335）
通信作者（Corresponding author），E⁃mail：hxu@njmu.edu.cn（ORCID：0000⁃0001⁃5827⁃1821）
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