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[目的]探讨淋巴结转移比例(MLR)对胃癌D2根治术患者的预后价值。[方法]回顾性分析行D2胃癌根治术89例患者的临床和随访资料。以MLR>20%为界,分为高比率组与低比率组,比较这两组患者临床病理特点及预后的差别。并从准确性、均一性2个方面分别比较MLR分期与pN分期的预后价值。[结果]MLR低比率组患者较高比率组患者的组织分化好且T分期、N分期、TNM分期早。MLR低比率组术后1、3年总生存率分别为87.2%、68.6%,高比率组术后1、3年总体生存率分别为25.6%、20.4%(P<0.001)。不同pN分期及不同MLR分期患者3年累积生存率(3-YCSR)的差异均有统计学意义(P<0.001);进一步经多因素预后分析显示,pN分期和MLR分期均可作为独立预后因素(P均<0.001)。ROC曲线显示,MLR分期预测结果所对应的曲线下面积大于pN分期,但差异无统计学意义。同一pN分期中不同MLR组间3-YCSR的差异无统计学意义(P>0.05)。[结论]胃癌D2根治术后患者MLR受病理类型、T分期、N分期、TNM分期影响,MLR高比率是胃癌D2根治术患者预后不良的重要因素之一;MLR与pN是预测胃癌生存的独立因素,MLR分期评估胃癌预后的准确性、均一性与pN分期相当。
[Objective] To investigate the prognostic value of lymph node metastasis (MLR) in patients with D2 gastric cancer radical resection. [Methods] The clinical and follow-up data of 89 patients undergoing D2 gastric cancer radical resection were retrospectively analyzed. To MLR> 20% as the boundary, divided into high-rate group and low-rate group, comparing the two groups of patients with clinicopathological features and prognosis. The prognostic value of MLR staging and pN staging were compared respectively in terms of accuracy and homogeneity. [Results] The patients with higher MLR rate had better tissue differentiation and had earlier T stage, N stage and TNM stage. The overall 1-year and 3-year postoperative survival rates in the MLR low-rate group were 87.2% and 68.6%, respectively. The overall 1-year and 3-year overall survival rates in the high rate group were 25.6% and 20.4%, respectively (P <0.001). The 3-year cumulative survival rates (3-YCSR) in patients with different pN stage and different MLR stages were significantly different (P <0.001). Further multivariate prognostic analysis showed that both pN stage and MLR stage could be used as independent prognostic factors (P <0.001). The ROC curve showed that the area under the curve corresponding to the MLR staging was larger than the pN stage, but the difference was not statistically significant. There was no significant difference in 3-YCSR between different MLR groups in the same pN stage (P> 0.05). [Conclusion] The MLR in patients with gastric cancer after radical resection of D2 is affected by pathological type, T stage, N stage and TNM stage. MLR high rate is one of the important prognostic factors in patients with gastric cancer with D2 radical surgery. MLR and pN are independent predictors of gastric cancer survival Factors, MLR staging to assess the accuracy of gastric cancer prognosis, homogeneity and pN staging.