中老年早期胃癌浸润深度相关因素分析及其与淋巴结转移的关系

梁松; 江频; 李靖; 方心安; 杨力

doi:10.16766/j.cnki.issn.1674-4152.001990

中老年早期胃癌浸润深度相关因素分析及其与淋巴结转移的关系

doi: 10.16766/j.cnki.issn.1674-4152.001990

梁松¹,
江频¹,
李靖²,
方心安¹,
杨力^3, ,

1.
六安市人民医院安徽医科大学附属六安医院普通外科，安徽六安 237000
2.
蚌埠医学院第一附属医院肿瘤外科，安徽蚌埠 233004
3.
江苏省人民医院南京医科大学第一附属医院普通外科，江苏南京 210029

基金项目:

国家自然科学基金 81874219

2019年度安徽高校自然科学研究项目 KJ2019A0368

详细信息

通讯作者:
杨力, E-mail: pwkyangli@163.com

中图分类号: R735.2 R73-37
计量
- 文章访问数: 224
- HTML全文浏览量: 105
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-06
- 网络出版日期: 2022-02-16

Analysis of the related factors of the invasion depth of gastric cancer in middle-aged and elderly patients

1.
Department of General Surgery, Lu'an People's Hospital (Lu'an Affiliated Hospital of Anhui Medical University), Lu'an, Anhui 237000, China

摘要

摘要: 目的研究中老年早期胃癌浸润深度与临床病理特征的相关性，探讨早期胃癌浸润深度的相关危险因素及其与淋巴结转移的关系。方法回顾分析2013年1月—2019年12月，六安市人民医院普通外科收治的110例中老年早期胃癌患者的临床及病理资料，分析早期胃癌浸润深度和淋巴结转移与各临床病理特征的关系，采用logistic回归模型分析早期胃癌浸润深度及淋巴结转移的独立危险因素。结果 110例患者中有54例肿瘤局限在黏膜层，其中53例无淋巴结转移，1例有淋巴结转移，56例肿瘤侵及黏膜下层，其中44例无淋巴结转移，12例有淋巴结转移。单因素分析表明，浸润深度不同的2组性别(P=0.739)、年龄(P=0.336)、大体分型(P=0.815)、肿瘤位置(P=0.410)、分化程度(P=0.519)、脉管癌栓(P=0.057)及神经侵犯(P=0.243)比较差异无统计学意义；肿瘤大小≥2 cm(P=0.005)及有淋巴结转移(P=0.001)的患者肿瘤侵及黏膜下层的比例高于黏膜层。多因素logistic分析结果显示肿瘤大小(P=0.016)为早期胃癌浸润深度的独立影响因素，进一步分析发现浸润深度(P=0.044)是早期胃癌淋巴结转移的独立影响因素。结论中老年早期胃癌浸润深度与肿瘤大小相关，肿瘤直径≥2 cm更容易出现肿瘤浸润黏膜下层，发生淋巴结转移的风险越大，建议临床上对于肿瘤直径≥2 cm且侵犯黏膜下层的早期胃癌患者选择内镜黏膜下剥离术和根治胃癌切除术时缩小手术清扫范围需谨慎对待。
- 胃癌早期 /
- 浸润深度 /
- 临床病理学特征 /
Abstract: Objective To analyze the correlation between the depth of infiltration of early gastric cancer (EGC) and clinicopathological features in middle-aged and elderly patients, and to explore the risk factors for the depth of infiltration of EGC and its relationship with lymph node metastasis (LNM). Methods The clinicopathological data of 110 patients with EGC admitted to the General Surgery Department of Lu'An Affiliated Hospital of Anhui Medical University from January 2013 to December 2019 were retrospectively collected. The relationship between the infiltration depth, LNM and clinicopathological features were analyzed. A logistic regression model was used to analyze the independent risk factors for the infiltration depth and LNM. Results Of the 110 patients, 54 had tumors confined to the mucosal layer, of which 53 patients had no LNMs and 1 had LNMs, and 56 had tumors invading the submucosal layer, of which 44 patients had no LNMs and 12 patients had LNMs. Univariate analysis showed no statistically significant differences between the two groups with different depth of infiltration in terms of gender (P=0.739), age (P=0.336), gross type classification (P=0.815), tumor location (P=0.410), differentiation (P=0.519), vascular invasion (P=0.057) and perineural invasion (P=0.243). Patients with tumor size ≥2 cm (P=0.005) and LNM (P=0.001) had a higher proportion of tumors invading the submucosa than those confined to the mucosal layer. Multivariate logistic regression analysis showed that tumor size (P=0.016) was an independent influence on the depth of infiltration of EGC, and further analysis revealed that the depth of infiltration (P=0.044) was an independent influence on LNM of EGC. Conclusion Tumor size was the independent risk factor of the tumor invasive depth. EGC with a tumor size of ≥2 cm may be more likely to have tumor invasion of the submucosal layer and a greater risk of LNM. It is recommended that the middle-aged and elderly patients with EGC whose tumor diameter is ≥2 cm and invades the submucosal layer should be careful when choosing endoscopic submucosal dissection or radical gastrectomy with inadequate lymph node dissection.
- Early gastric cancer /
- Tumor invasive depth /
- Clinicopathological characteristics /
- Lymph node metastasis

HTML全文

表 1 中老年早期胃癌浸润深度相关因素的单因素分析(例)

因素	例数	黏膜层组(n=54)	黏膜下层组(n=56)	χ²值	P值
性别				0.111	0.739
男性	87	42	45
女性	23	12	11
年龄(岁)				0.925	0.336
< 60	32	18	14
≥60	78	36	42
大体分型				0.408	0.815
隆起型	5	2	3
平坦型	34	18	16
凹陷型	71	34	37
肿瘤位置				1.781	0.410
胃上1/3	20	8	12
胃中1/3	13	5	8
胃下1/3	77	41	36
肿瘤大小				7.903	0.005
< 2 cm	69	41	28
≥2 cm	41	13	28
淋巴结转移				10.110	0.001
无	97	53	44
有	13	1	12
分化程度				0.416	0.519
未分化型	14	8	6
分化型	96	46	50
脉管癌栓				5.051	0.057
无	106	54	52
有	4	0	4
神经侵犯				2.974	0.243
无	107	54	53
有	3	0	3

下载: 导出CSV

表 2 中老年早期胃癌浸润深度的多因素logistic分析

因素	B	SE	Wald χ²	P值	OR值	95% CI
肿瘤大小(1)	-1.049	0.434	5.833	0.016	0.350	0.149~0.821
淋巴结转移(1)	-1.789	1.111	2.594	0.107	0.167	0.019~1.474
注：自变量赋值如下，淋巴结转移(无=1；有=0)；肿瘤大小(< 2 cm=1；≥2 cm=0)；浸润深度(黏膜层=1；黏膜下层=0)。

下载: 导出CSV

表 3 中老年早期胃癌淋巴结转移多因素logistic分析

因素	B	SE	Wald χ²	P值	OR值	95% CI
浸润深度(1)	-2.219	1.102	4.051	0.044	0.109	0.013~0.943
肿瘤大小(1)	-1.132	0.609	3.457	0.063	0.322	0.098~1.063
注：分类变量编码如下，浸润深度(黏膜层=1；黏膜下层=0)；肿瘤大小(< 2 cm=1；≥2 cm=0)。

下载: 导出CSV

参考文献(19)

[1]	张庆瑞, 张月明, 薛丽燕, 等. 内镜黏膜下剥离术治疗早期胃癌的疗效分析[J]. 中华肿瘤杂志, 2020, 42(9): 752-757. doi: 10.3760/cma.j.cn112152-20200414-00343
[2]	PETRYSZYN P, CHAPELLE N, MATYSIAK-BUDNIK T. Gastric cancer: Where are we heading? [J]. Dig Dis, 2020, 38(4): 280-285. doi: 10.1159/000506509
[3]	高源, 彭贵勇. 早期胃癌淋巴结转移规律的临床病理因素研究[J]. 中华消化内镜杂志, 2020, 37(4): 257-258, 261. doi: 10.3760/cma.j.cn321463-20191021-00702
[4]	武颖超, 谢淼, 蔡云龙, 等. 早期胃癌淋巴结转移规律及其预后分析[J]. 中华普通外科杂志, 2019, 34(7): 561-564. doi: 10.3760/cma.j.issn.1007-631X.2019.07.001
[5]	SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2019[J]. Cancer J Clin, 2019, 69(1): 7-34. doi: 10.3322/caac.21551
[6]	盛圆, 王业涛, 叶飞, 等. 黏膜内早期胃癌青年患者临床病理特征及内镜下治疗适应证的探讨[J]. 中国肿瘤临床, 2019, 46(6): 284-287. doi: 10.3969/j.issn.1000-8179.2019.06.127
[7]	WU J, ZHANG X X, ZOU X, et al. A clinical study of traditional Chinese medicine prolonging the survival of advanced gastric cancer patients by regulating the immunosuppressive cell population: A study protocol for a multicenter, randomized controlled trial[J]. Medicine (Baltimore), 2020, 99(16): e19757. doi: 10.1097/MD.0000000000019757
[8]	王珣, 张鹏, 刘智明, 等. MiR-22靶向调控CD151促进胃癌血管新生的机制研究[J]. 中华全科医学, 2018, 16(12): 1984-1988. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201812010.htm
[9]	夏明杰, 王权. 保留贲门的胃节段切除术在早期胃癌手术中的应用[J]. 中华胃肠外科杂志, 2020, 23(10): 931-934. doi: 10.3760/cma.j.cn.441530-20200711-00414
[10]	张楠楠, 邓靖宇. 从术后生活质量看保留迷走神经远端胃癌根治术在早期胃癌治疗中的应用[J]. 中华胃肠外科杂志, 2017, 20(9): 1085-1086. doi: 10.3760/cma.j.issn.1671-0274.2017.09.027
[11]	李子禹, 高翔宇. 回眸2018——聚焦胃癌研究领域[J]. 中华胃肠外科杂志, 2019, 22(1): 1-8. doi: 10.3760/cma.j.issn.1671-0274.2019.01.001
[12]	KINAMI S, NAKAMURA N, TOMITA Y, et al. Precision surgical approach with lymph-node dissection in early gastric cancer[J]. World J Gastroenterol, 2019, 25(14): 1640-1652. doi: 10.3748/wjg.v25.i14.1640
[13]	周潮平, 汤代彬, 汪大田, 等. 单中心186例早期胃癌区域淋巴结转移特征与预后分析[J]. 中国普通外科杂志, 2019, 28(10): 1221-1227. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201910010.htm
[14]	金超琼, 应笑, 吕宾. 早期胃癌内镜下非治愈性切除患者淋巴结转移的危险因素[J]. 中华消化杂志, 2020, 40(3): 208-209, 211. doi: 10.3760/cma.j.issn.0254-1432.2020.03.015
[15]	李杭, 潘志坚, 武伟, 等. T1a~T1b期胃癌患者发生脉管浸润的风险因素及预后分析[J]. 中华全科医学, 2019, ,17(3): 367-369, 387. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201903008.htm
[16]	孙本龙, 马婷婷, 邱谢武, 等. 女性早期胃癌患者淋巴结转移的危险因素分析[J]. 中华普通外科学文献(电子版), 2020, 14(2): 115-117. doi: 10.3877/cma.j.issn.1674-0793.2020.02.009
[17]	KIM S M, LEE H, MIN B H, et al. A prediction model for lymph node metastasis in early-stage gastric cancer: Toward tailored lymphadenectomy[J]. J Surg Oncol, 2019, 120(4): 670-675.
[18]	石琳娜, 隋红. 早期胃癌淋巴结转移评估方法的研究现状[J]. 实用肿瘤学杂志, 2020, 34(3): 286-290. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZL202003025.htm
[19]	陈路川, 魏晟宏, 叶再生, 等. 青年胃癌患者的临床病理特点与预后分析[J]. 中华普通外科杂志, 2017, 32(4): 289-292. doi: 10.3760/cma.j.issn.1007-631X.2017.04.002