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目的探讨淋巴结转移率(MLR)预测T3期胃癌病人术后生存时间的价值。方法回顾性研究89例接受根治性手术(≥D2)的T3期胃癌病人,Spearman相关性分析研究MLR及阳性淋巴结个数是否与病检淋巴结总数(≥15个)具有相关性,单因素Kaplan-Meier生存分析和多因素Cox比例风险回归分析研究MLR对术后生存时间的影响,ROC曲线判定MLR预测T3期胃癌病人术后2年内死亡的准确性,并与阳性淋巴结个数比较。结果(1)MLR高低与病检淋巴结总数无相关性(r=-0·0022,P>0·05),而阳性淋巴结个数与病检淋巴结总数则具有相关性(r=0·2504,P<0·05)。(2)Kaplan-Meier生存分析发现MLR影响术后生存时间(Log-rankχ2=35·7470,P<0·01),Cox比例风险回归分析提示MLR越高,病人死亡风险性越大(χ2=7·9708,P<0·01)。(3)MLR预测病人术后2年内死亡的ROC曲线下面积与阳性淋巴结个数的差异不具统计学意义。结论病检淋巴结≥15个时,T3期胃癌MLR高低与病检淋巴结总数不相关,在清扫范围足够的情况下,MLR预测T3期胃癌病人术后2年内死亡的准确性与阳性淋巴结个数相当,但并不优于后者。
Objective To investigate the value of lymph node metastasis (MLR) in predicting the postoperative survival time of patients with stage T3 gastric cancer. Methods A retrospective study of 89 patients with T3 gastric cancer undergoing radical surgery (≥ D2) was performed. Spearman correlation analysis was performed to determine whether MLR and the number of positive lymph nodes correlated with the total number of lymph nodes (≥15). Kaplan- Meier survival analysis and multivariate Cox proportional hazards regression analysis to study the effect of MLR on postoperative survival time. The ROC curve was used to determine the accuracy of MLR in predicting the death of patients with T3 gastric cancer within 2 years after operation and to compare with the number of positive lymph nodes. Results (1) There was no correlation between the level of MLR and the total number of lymph nodes (r = -0.0022, P> 0.05), while the number of positive lymph nodes was correlated with the total number of lymph nodes (r = 0.2504, P <0 · 05). (2) Kaplan-Meier survival analysis showed that MLR had an effect on postoperative survival time (Log-rank2 = 35.7470, P <0.01). Cox proportional hazards regression analysis indicated that the higher the MLR, the greater the risk of death (χ2 = 7 · 9708, P <0.01). (3) The area under the curve of ROC curve and the number of positive lymph nodes that MLR predicted to die within 2 years after MLR were not statistically significant. Conclusions The MLR of stage Ⅲ gastric cancer is not correlated with the total number of lymph nodes in stage Ⅲ disease test. When MLR is sufficient, MLR predicts that the accuracy of death within 3 years after operation is similar to the number of positive lymph nodes , But not better than the latter.