摘要
目的探讨肝十二指肠韧带淋巴结(hepatoduodenal lymph node,HDLN)转移对胃癌预后的影响。方法对2015年7月至2017年6月于广州中医药大学顺德医院进行胃癌D2根治术的120例患者的临床病理资料进行回顾性分析,依据病理分期及HDLN是否发生转移进行对比研究,资料收集方式为电话或门诊随访。比较各病理分期5年生存率,分析胃癌预后的危险因素。结果 120例患者中,60例发生HDLN转移。年龄较大、肿瘤晚期、未分化组织类型、淋巴管浸润、血管浸润和神经周围浸润均与HDLN转移有显著的相关性;病理分期Ⅲ期及以下的HDLN阳性患者其5年生存率显著高于Ⅳ期患者(59.3%vs 18.8%,P<0.05);病理分期Ⅲ期HDLN阳性患者其5年生存率显著低于HDLN阴性患者(51.7%vs 66.3%,P<0.05);多因素回归分析结果显示,年龄、切除范围、分化、浸润深度、远处转移、病理分期、淋巴管浸润、血管浸润、神经周围浸润、HDLN转移是影响预后的独立危险因素。结论虽然HDLN阳性为局部扩散,HDLN与其他区域淋巴结对于胃癌晚期的预后意义不尽相同。HDLN阳性是影响胃癌预后的独立危险因素,故胃癌患者的生存结局需结合HDLN是否为阳性进行考虑。
Objective To investigate the effect of hepatoduodenal lymph node(HDLN)metastasis on the prognosis of gastric cancer.Methods One hundred and twenty gastric cancer patients with radical gastrectomy from Jul.2015 to Jun.2017 were selected for retrospective analysis.According to the pathological stage and HDLN metastasis of the comparative study,data collection methods were telephone or outpatient follow-up.The 5-year survival rate of each pathological stage was compared,the prognostic factors of gastric cancer were analyzed.Results All of the patients,60 cases of patients occurred HDLN metastasis.Older age,advanced tumors,undifferentiated type of tissue,lymphatic invasion,vascular invasion,perineural invasion were significantly associated with HDLN metastasis.The 5-year survival rate of HDLN-positive patients with stageⅢand below was significantly higher than that of patients with stageⅣ(59.3%vs 18.8%,P<0.05).The 5-year survival rate of stageⅢHDLN-positive patients was significantly lower than that of HDLN-negative patients(51.7%vs 66.3%,P<0.05).Multivariate regression analysis showed that age,range of excision,differentiation,infiltration depth,distant metastasis,pathological stage,lymphatic invasion,vascular invasion,perineural invasion and HDLN metastasis were independent risk factors for prognosis.Conclusion Although HDLN positive is regional metastasis,HDLN and other regional lymph nodes have different meanings for the prognosis of gastric cancer.HDLN positive is an independent risk factor for the prognosis of gastric cancer,therefore,the outcome of gastric cancer patients need to be combined with HDLN positive for consideration.
作者
梁澄照
LIANG Chengzhao(Department of NO.1 Surgery,Shunde Hospital of Guangzhou University of Chinese Medicine,Foshan 528333,China)
出处
《胃肠病学和肝病学杂志》
CAS
2018年第4期379-383,共5页
Chinese Journal of Gastroenterology and Hepatology
关键词
肝十二指肠韧带淋巴结
胃癌
胃切除术
预后
病理分期
Hepatoduodenal lymph node
Gastric cancer
Gastrectomy
Prognosis
Pathological staging
