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目的研究胃黏膜下层癌淋巴结转移率及其影响因素。方法回顾性分析南京医科大学第一附属医院1998年1月至2007年12月手术证实的181例胃黏膜下层癌的临床病理资料,对病人年龄、性别、肿瘤组织学类型、形态学类型、大小、部位、浸润深度、脉管内癌栓等与淋巴结转移的关系进行单因素与多因素分析。结果胃黏膜下层癌淋巴结转移率为20.44%。影响胃黏膜下层癌淋巴结转移的因素主要有肿瘤组织学类型(分化型vs分化不良型,P=0.0352)、直径大小(<2cmvs≥2cm,P=0.0143)、部位(近端胃vs胃体vs远端胃,P=0.0254)及脉管内癌栓(无vs有,P=0.0323)。Logistic回归分析显示肿瘤组织学类型与大小为胃黏膜下层癌淋巴结转移的独立性危险因素。结论胃黏膜下层癌淋巴结转移与肿瘤组织学类型、大小、部位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,制定合适的治疗方案。
Objective To study the lymph node metastasis rate of gastric submucosa and its influencing factors. Methods The clinical and pathological data of 181 cases of gastric submucosal carcinoma confirmed by operation from January 1998 to December 2007 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The age, gender, histological type, morphological type, , Location, depth of invasion, intravascular thrombosis and lymph node metastasis of single factor and multivariate analysis. Results The rate of lymph node metastasis in gastric submucosa was 20.44%. The main influencing factors of lymph node metastasis in gastric submucosa were tumor histological type (differentiation type vs poor differentiation type, P = 0.0352), diameter size (<2cmvs≥2cm, P = 0.0143) Distal stomach, P = 0.0254) and intravascular thrombosis (no vs yes, P = 0.0323). Logistic regression analysis showed that histological type and size were independent risk factors for lymph node metastasis in gastric submucosa. Conclusion The lymph node metastasis of gastric cancer is related to tumor histological type, size, location and intravascular thrombus. Clinic should refer to the above clinical and pathological factors to determine the risk of lymph node metastasis, develop appropriate treatment options.