摘要
目的探讨影响胃腺癌淋巴结转移率(MLR)因素及其与预后的关系。方法绘制受试者工作特征曲线(ROC曲线),确定MLR分组的截断点;应用CK20检测淋巴结微转移;进而研究MLR与预后、N分期、病理特征、微转移的关系。结果121例胃腺癌患者,MLR预测术后3,5年内死亡的ROC曲线下面积分别为0.826±0.053,0.896±0.046,截断点分别为MLR=30.95%,MLR=3.15%。据此分组:MLR1(MLR<3.15%),MLR2(3.15%≤MLR≤30.95%)及MLR3(MLR>30.95%)。生存分析显示:MLR值越高,预后越差(P=0.000);MLR是患者死亡的独立影响因素(P=0.000)。相同N分期(N1或N2)患者,MLR不同,预后差异有统计学意义(P<0.05)。HE染色和CK染色总MLR分别为34.7%(242/697)和43.5%(303/697),两者差异有统计学意义(P=0.001)。说明微转移的检测能明显改变MLR值。无论是HE染色还是CK染色,MLR都与肿瘤淋巴管浸润、肿瘤浸润深度有关(P<0.05)。结论MLR预测术后3年或5年内死亡的ROC曲线下面积大,是一个可靠的指标,可用于确定其分组的截断点,进而指导临床判断预后。淋巴结微转移的检测能显著改变MLR值。
Objective To study the influential factors on metastatic lymph nodes ratio （MLR） and the relationships between MLR and prognosis. Methods The clinical data of 121 patients with gastric adenocarcinoma were analysed. The receiving operating characteristic curve （ROC curve ） was used to determine the cutoff of MLR and the CK20 immunihistochemical staining was used to detect the lymph nodes micrometastasis. Results The area under the ROC curve of MLR to predict the death of patients at 3-year or 5-year postoperatively was 0. 826±0. 053 and 0. 896±0. 046, so MLR = 30. 95% and MLR = 3.15% were selected as the cutoffs. Then the MLR was classified furthermore into three groups： MLR1 （MLR〈3. 15%）, MLR2（3. 15% ≤MLR≤30.95%） and MLR3（MLR 〉30.95%）. The survival curve showed that the higher the MLR value the lower survival period after radical operation （ P = 0. 000 ） .COX model showed the MLR was an independent prognostic factor （ P = 0. 000）. The MLR also discriminated subsets of patients with different 5-year survivals the same N stage （ P 〈 0. 05 ）. The MLR proved to be 34.7% （ 242/697 ） by HE staining and 43. 5% （ 303/697 ） by CK staining respectively （P= 0. 001 ）. Thus, the detection of micrometastasis by CK staining changed the MLR significantly. The lymph vessel invasion and depth of invasion was significantly related to the MLR. Conclusions The area under the ROC curve of MLR in predicting the death of patients at 3-or 5 -years postoperatively is very large, and it seems to be a good way to determine the group cutoff. Therefore, the MLR seems to be meaningful parameter in detecting the prognosis of gastric adenocarcinoma. The detection of lymph nodes micrometastasis could change the MLR significantly.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2009年第4期311-317,共7页
China Journal of General Surgery
基金
上海市卫生局科研基金赞助(034086)
关键词
胃肿瘤
腺癌
淋巴结转移率
预后
微转移
Stomach Neoplasms
Adenocarcinoma
Metastatic Lymph Nodes Ratio
Prognosis
Micrometastasis
