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目的:评价淋巴结转移率(MLR)对胃癌术后患者预后的预测价值。方法:回顾性分析2004年至2006年间在我院就诊,临床资料完整的363例胃癌术后患者。按照第七版UICC/TNM(pN分期)及淋巴结转移率两种方法对淋巴结进行分期,比较两种方法评价胃癌预后的准确性及适用性,确定MLR分期方法的特点及优势。结果:363例胃癌术后患者按单变量生存分析方法将淋巴结转移率(MLR)分为四期:MLR0(0.0%)、MLR1(0-30%)、MLR2(30-70%)、MLR3(≥70%),其5年生存率分别为84.9%、58.3%、28.7%、12.9%,有显著性统计学差异(P<0.001)。pN分期分为pN0、pN1、pN2、pN3a、pN3b,其5年生存率分别为84.9%、60.8%、32.0%、21.9%、6.8%,有显著性统计学差异(P<0.001)。单因素COX生存分析后显示,MLR分期越高,预后越差(HR:MLR1,MLR2,MLR3/MLR0=1.589,4.455,9.900,P<0.001)。按清除淋巴结个数将所有病例分成两组:group1(≤15个)、group2(>15个),在该两组中比较pN及MLR分期的预后,结果显示pN3a在group1组中的5年生存率明显低于group2组(6.2%vs.38.4%,P<0.001),而MLR分期与清除淋巴结个数无统计学生存相关差异(P>0.05)。COX比例风险模型多因素分析表明,pN分期、MLR分期、肿瘤浸润深度、肿瘤分化程度均为影响预后的独立因素,以pN及MLR分期风险比最高。结论:MLR分期是评价胃癌术后患者预后的独立因素,该方法不受淋巴结清扫个数的影响,与pN分期方法相比,实用、准确、简单,可以降低pN分期因淋巴结清扫不足造成的期别转移现象。
Objective: To evaluate the predictive value of lymph node metastasis (MLR) in the prognosis of gastric cancer patients. Methods: A retrospective analysis of 363 cases of postoperative patients with gastric cancer who were treated in our hospital from 2004 to 2006 with complete clinical data was conducted. According to the seventh edition of UICC / TNM (pN staging) and lymph node metastasis rate of two methods of lymph node staging, compared two methods to evaluate the accuracy and applicability of gastric cancer prognosis to determine the characteristics and advantages of MLR staging method. Results: 363 cases of postoperative patients with gastric cancer were divided into four phases according to univariate survival analysis: MLR0 (0%), MLR1 (0-30%), MLR2 (30-70%), MLR3 ≥70%). The 5-year survival rates were 84.9%, 58.3%, 28.7% and 12.9% respectively, with significant statistical difference (P <0.001). The 5-year survival rates of pN0, pN1, pN2, pN3a and pN3b in pN stage were 84.9%, 60.8%, 32.0%, 21.9% and 6.8%, respectively. There was a significant statistical difference (P <0.001). Single-factor COX survival analysis showed that the higher the MLR staging, the worse the prognosis (HR: MLR1, MLR2, MLR3 / MLR0 = 1.589,4.455,9.900, P <0.001). All cases were divided into two groups according to the number of lymph nodes removed: group1 (≤15) and group2 (> 15). The prognosis of pN and MLR staging was compared between the two groups. The results showed that pN3a had a 5-year survival in group1 The rate of lymph node metastasis was significantly lower than that of group2 (6.2% vs.38.4%, P <0.001). There was no significant difference in the number of lymph node dissection between MLR stage and lymph node dissection (P> 0.05). COX proportional hazard model multivariate analysis showed that pN stage, MLR stage, tumor invasion depth, tumor differentiation are independent prognostic factors, with pN and MLR staging the highest risk ratio. Conclusion: MLR staging is an independent factor to evaluate the postoperative prognosis of patients with gastric cancer. The method is not affected by the number of lymph node dissection. Compared with the pN staging method, MLR staging is practical, accurate and simple and can reduce the risk of pN staging due to inadequate lymph node dissection Do not transfer phenomenon.