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早期胃癌淋巴结转移与预后影响因素分析

贺敬扬, 李恩泽, 于鹏程, 张延强, 胡灿, 程向东, 徐志远

贺敬扬, 李恩泽, 于鹏程, 等. 早期胃癌淋巴结转移与预后影响因素分析[J]. 中华消化外科杂志, 2023, 22(9): 1093-1099. DOI: 10.3760/cma.j.cn115610-20230831-00050
引用本文: 贺敬扬, 李恩泽, 于鹏程, 等. 早期胃癌淋巴结转移与预后影响因素分析[J]. 中华消化外科杂志, 2023, 22(9): 1093-1099. DOI: 10.3760/cma.j.cn115610-20230831-00050
He Jingyang, Li Enze, Yu Pengcheng, et al. Influencing factors for lymph node metastasis and prognosis in early gastric cancer[J]. Chinese Journal of Digestive Surgery, 2023, 22(9): 1093-1099. DOI: 10.3760/cma.j.cn115610-20230831-00050
Citation: He Jingyang, Li Enze, Yu Pengcheng, et al. Influencing factors for lymph node metastasis and prognosis in early gastric cancer[J]. Chinese Journal of Digestive Surgery, 2023, 22(9): 1093-1099. DOI: 10.3760/cma.j.cn115610-20230831-00050

早期胃癌淋巴结转移与预后影响因素分析

基金项目: 

十四五国家重点研发计划 2021YFA0910100

浙江省上消化道肿瘤诊治技术研究中心 JBZX-202006

浙江省医药卫生计划—省部共建项目 WKJ-ZJ-2202

国家自然科学基金 82074245

详细信息
    通讯作者:

    徐志远,Email:xuzy@zjcc.org.cn

Influencing factors for lymph node metastasis and prognosis in early gastric cancer

Funds: 

National Key R&D Program 2021YFA0910100

Zhejiang Upper Gastrointes-tinal Cancer Diagnosis and Treatment Technology Research Center JBZX-202006

Zhejiang Medical and Health Program-Provincial Joint Construction Project WKJ-ZJ-2202

National Natural Science Foundation of China 82074245

More Information
  • 摘要:
    目的 

    探讨影响早期胃癌淋巴结转移与预后的因素。

    方法 

    采用回顾性队列研究方法。收集2010年1月至2019年12月浙江省肿瘤医院收治的1 011例早期胃癌患者的临床病理资料;男561例,女450例;年龄为(58±11)岁。患者行胃癌根治术治疗。根据患者手术标本的病理学检查结果,明确各组淋巴结转移情况。观察指标:(1)早期胃癌淋巴结转移情况。(2)早期胃癌淋巴结转移的影响因素分析。(3)早期胃癌患者预后的影响因素分析。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数或百分数表示,组间比较采用χ²检验。等级资料比较,采用非参数秩和检验。单因素分析采用Log‑Rank检验和Logistic回归模型。多因素分析采用Logistic逐步回归模型和COX逐步回归模型。采用Kaplan‑Meier法计算生存率和绘制生存曲线,采用Log‑Rank检验进行生存分析。

    结果 

    (1)早期胃癌淋巴结转移情况。1 011例早期胃癌患者淋巴结转移率为23.640%(239/1 011),其中T1a期患者淋巴结转移率为11.883%(53/446),T1b期患者淋巴结转移率为32.920%(186/565)。239例淋巴结转移患者转移淋巴结主要集中在第一站淋巴结,第1、2、3、4、5、6、7、8、9、10组淋巴结转移分别为7、11、135、59、39、91、6、8、8、6例,同1例患者可能存在多处淋巴结转移。不同肿瘤部位淋巴结转移情况:胃上部肿瘤第2组、第3组、第5组淋巴结转移分别为4、2、1例;胃中部肿瘤第1组、第2组、第3组、第4组、第5组、第6组淋巴结转移分别为3、7、36、15、3、5例;胃下部肿瘤第1组、第3组、第4组、第5组、第6组淋巴结转移分别为4、97、44、35、86例。(2)早期胃癌淋巴结转移的影响因素分析。多因素分析结果显示:肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是早期胃癌患者淋巴结转移的独立影响因素(优势比=1.80,1.49,2.65,5.76,0.60,95%可信区间为1.29~2.50,1.11~2.00,1.81~3.88,3.87~8.59,0.48~0.76,P<0.05)。(3)早期胃癌患者预后的影响因素分析。1 011例早期胃癌患者均获得术后随访,随访时间为43(0~135)个月,3年总生存率为97.32%。多因素分析结果显示:年龄>60岁、淋巴结转移是影响早期胃癌患者预后的独立危险因素(风险比=9.50,2.20,95%可信区间为3.31~27.29,1.00~4.87,P<0.05)。进一步分析结果显示:年龄>60岁与年龄≤60岁胃癌患者的3年总生存率分别为99.37%和94.66%,两者比较,差异有统计学意义(χ²=25.33,P<0.05)。有淋巴结转移与无淋巴结转移患者的3年总生存率分别为95.42%和97.92%,两者比较,差异有统计学意义(χ²=5.69,P<0.05)。

    结论 

    早期胃癌淋巴结转移率达23.640%,肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是影响早期胃癌患者淋巴结转移的独立影响因素;年龄>60岁、淋巴结转移是影响早期胃癌预后的独立危险因素。

    Abstract:
    Objective 

    To investigate the influencing factors for lymph node metastasis and prognosis in early gastric cancer.

    Methods 

    The retrospective cohort study was conducted. The clinicopathological data of 1 011 patients with early gastric cancer who were admitted to the Zhejiang Cancer Hospital from January 2010 to December 2019 were collected. There were 561 males and 450 females, aged (58±11)years. All patients underwent radical resection of gastric cancer and the lymph node metastasis of each group was identified according to the pathological examination on patients' surgical specimens. Observation indicators: (1) lymph node metastasis in early gastric cancer; (2) influencing factors for lymph node metastasis in early gastric cancer; (3) influencing factors for prognosis in early gastric cancer. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was analyzed using the non‐parameter rank sum test. Univariate analysis was conducted using the Log-Rank test and Logistic regression model, and multivariate analysis was conducted using the Logistic stepwise regression model and COX step-wise regression model. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and the Log-Rank test was used for survival analysis.

    Results 

    (1) Lymph node metastasis in early gastric cancer. The lymph node metastasis rate of 1 011 patients with early gastric cancer was 23.640%(239/1 011), in which the lymph node metastasis rate of patients with T1a stage gastric cancer was 11.883%(53/446), and the lymph node metastasis rate of patients with T1b stage gastric cancer was 32.920%(186/565). There were 239 patients with lymph node metastasis mainly concentrated in the first station, including 7 cases with No.1 lymph node metastasis, 11 cases with No.2 lymph node metastasis, 135 cases with No.3 lymph node metastasis, 59 cases with No.4 lymph node metastasis, 39 cases with No.5 lymph node metastasis, 91 cases with No.6 lymph node metastasis, 6 cases with No.7 lymph node metastasis, 8 cases with No.8 lymph node metastasis, 8 cases with No.9 lymph node metastasis and 6 cases with No.10 lymph node metastasis. Multiple lymph node metastases may exist in the same patient. For lymph node metastasis in different tumor sites, there were 4 cases, 2 cases and 1 case of lymph node metastasis in the No.2, 3 and 5 lymph node in patients with upper gastric cancer. There were 3 cases, 7 cases, 36 cases, 15 cases, 3 cases and 5 cases of lymph node metastasis in the No.1, 2, 3, 4, 5 and 6 lymph node in patients with middle gastric cancer. There were 4 cases, 97 cases, 44 cases, 35 cases and 86 cases of lymph node metastasis in the No.1, 3, 4, 5 and 6 lymph node in patients with lower gastric cancer. (2) Influencing factors for lymph node metastasis in early gastric cancer. Results of multivariate analysis showed that tumor diameter, tumor location, degree of tumor invasion, vascular thrombus, degree of tumor differentiation were independent factors influencing lymph node metastasis in early gastric cancer (odds ratio=1.80, 1.49, 2.65, 5.76, 0.60, 95% confidence interval as 1.29-2.50, 1.11-2.00, 1.81-3.88, 3.87-8.59, 0.48-0.76, P<0.05). (3) Influencing factors for prognosis in early gastric cancer. All 1 011 patients were followed up for 43(range, 0-135)months, and the 3-year overall survival rate was 97.32%. Results of multivariate analysis showed that age >60 years and lymph node metastasis were independent risk factors influencing prognosis in early gastric cancer (hazard ratio=9.50, 2.20, 95% confidence interval as 3.31-27.29, 1.00-4.87, P<0.05). Results of further analysis showed that the 3-year overall survival rate was 99.37% and 94.66% in patient with age >60 years and ≤60 years, respectively, showing a significant difference between them (χ2=25.33, P<0.05). The 3-year overall survival rate was 95.42% and 97.92% in patients with and without lymph node metastasis, respectively, showing a significant difference between them (χ2=5.69, P<0.05).

    Conclusions 

    The lymph node metastasis rate of early gastric cancer can reach 23.640%. Tumor diameter, tumor location, degree of tumor invasion, vascular thrombus, degree of tumor differentia-tion are independent factors influencing lymph node metastasis in early gastric cancer, age >60 years and lymph node metastasis are independent risk factors influencing prognosis.

  • 早期胃癌是指癌组织局限于胃黏膜或黏膜下层的腺癌,不论肿瘤大小和有无淋巴结转移[1]。近年来,随着我国胃癌诊断与治疗水平的不断提高,早期胃癌的检出率也不断提高,5年生存率>90%[2],虽然早期胃癌预后较好,但淋巴结转移的早期胃癌患者5年生存率明显低于没有淋巴结转移患者[3]。淋巴结转移状态决定早期胃癌的治疗方式,影响预后[47]。本研究回顾性分析2010年1月至2019年12月我科收治的1 011例早期胃癌患者的临床病理资料,探讨影响早期胃癌淋巴结转移与预后的因素。

    采用回顾性队列研究方法。收集1 011例早期胃癌患者的临床病理资料;男561例,女450例;年龄为(58±11)岁。1 011例患者中,肿瘤长径≤2 cm 577例,>2 cm 434例;肿瘤分化程度为高分化214例,中分化296例,低分化501例;肿瘤位置为胃上部90例,胃中部193例,胃下部728例;肿瘤浸润深度为黏膜层(T1a期)446例,黏膜下层(T1b期)565例。本研究通过浙江省肿瘤医院医学伦理委员会审批,批号为IRB‑2022‑371。患者及家属均签署知情同意书。

    纳入标准:(1)术后病理学检查证实为早期胃癌。(2)行胃癌根治术治疗。(3)术前未行抗肿瘤治疗。(4)临床病理资料完整。

    排除标准:(1)术后病理学检查证实为进展期胃癌。(2)术前新辅助治疗史。(3)合并其他恶性肿瘤。(4)残胃癌。(5)复发癌。(6)特殊类型胃肿瘤,如淋巴瘤、神经内分泌瘤、间质瘤等。(7)临床病理资料缺失。

    患者行胃癌根治术治疗。根据患者手术标本的病理学检查结果,按照第13版胃癌处理规约分站统计,明确各组淋巴结转移情况。

    观察指标:(1)早期胃癌淋巴结转移情况包括淋巴结转移率、不同T分期淋巴结转移率、不同组别淋巴结转移情况、不同部位淋巴结转移情况。(2)早期胃癌淋巴结转移的影响因素分析:性别、年龄、BMI、胃癌家族史、吸烟史、饮酒史、肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、神经侵犯、肿瘤分化程度。(3)早期胃癌患者预后的影响因素分析:获得随访的患者例数,随访时间,患者生存情况。临床病理因素包括性别、年龄、BMI、胃癌家族史、吸烟史、饮酒史、肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、神经侵犯、肿瘤分化程度、淋巴结转移。

    评价标准:根据AJCC第8版TNM分期标准对进行肿瘤T分期和N分期。

    采用门诊或电话方式进行随访,了解患者生存情况。随访时间截至2022年5月。

    应用SPSS 25.0统计软件进行分析。正态分布的计量资料以x±s表示,组间比较采用t检验。计数资料以绝对数或百分数表示,组间比较采用χ²检验。等级资料比较采用非参数秩和检验。单因素分析采用Log⁃Rank检验和Logistic回归模型。多因素分析采用Logistic逐步回归模型和COX逐步回归模型。采用Kaplan‑Meier法计算生存率和绘制生存曲线,采用Log‑Rank检验进行生存分析。P<0.05为差异有统计学意义。

    1 011例早期胃癌患者淋巴结转移率为23.640%(239/1 011),其中T1a期患者淋巴结转移率为11.883%(53/446),T1b期患者淋巴结转移率为32.920%(186/565)。239例淋巴结转移患者转移淋巴结主要集中在第一站淋巴结,第1、2、3、4、5、6、7、8、9、10组淋巴结转移分别为7、11、135、59、39、91、6、8、8、6例,同1例患者可能存在多处淋巴结转移。不同肿瘤部位淋巴结转移情况:胃上部肿瘤第2组、第3组、第5组淋巴结转移分别为4、2、1例;胃中部肿瘤第1组、第2组、第3组、第4组、第5组、第6组淋巴结转移分别3、7、36、15、3、5例;胃下部肿瘤第1组、第3组、第4组、第5组、第6组淋巴结转移分别为4、97、44、35、86例。

    单因素分析结果显示:肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、神经侵犯、肿瘤分化程度是影响早期胃癌患者淋巴结转移的相关因素(P<0.05);性别、年龄、BMI、胃癌家族史、吸烟史、饮酒史不是影响早期胃癌患者淋巴结转移的相关因素(P>0.05)。见表1

    表  1  影响1 011例早期胃癌患者淋巴结转移的单因素分析(例)
    Table  1.  Univariate analysis of lymph node metastasis in 1 011 patients with early gastric cancer (case)
    临床病理因素赋值有淋巴结转移(239例)无淋巴结转移(772例)统计量值P
    性别
    1131430χ²=0.060.809
    0108342
    年龄
    ≤60岁0131432χ²=0.100.755
    >60岁1108340
    体质量指数
    ≤24 kg/m21162539χ²=0.560.511
    >24 kg/m2077233
    胃癌家族史
    192284χ²=0.230.633
    0147488
    吸烟史
    184266χ²=0.040.845
    0155506
    饮酒史
    167191χ²=1.040.308
    0172581
    肿瘤长径
    ≤2 cm099478χ²=31.29<0.001
    >2 cm1140294
    肿瘤部位
    胃上部1684χ²=15.82<0.001
    胃中部250143
    胃下部3183545
    肿瘤浸润深度
    黏膜内层053393χ²=61.11<0.001
    黏膜下层1186379
    脉管癌栓
    010264χ²=157.26<0.001
    1137708
    神经侵犯
    02124χ²=13.83<0.001
    1218748
    肿瘤分化程度
    低分化1125376Z=-2.450.014
    中分化288208
    高分化326188
    下载: 导出CSV 
    | 显示表格

    多因素分析结果显示:肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是早期胃癌患者淋巴结转移的独立影响因素(P<0.05)。见表2

    表  2  影响1 011例早期胃癌患者淋巴结转移的多因素分析
    Table  2.  Multivariate analysis of lymph node metastasis in 1 011 patients with early gastric cancer
    临床病理因素回归系数标准误Wald优势比95%可信区间P
    肿瘤长径0.590.1712.151.801.29~2.50<0.001
    肿瘤部位0.400.157.101.491.11~2.000.008
    肿瘤浸润深度0.970.2024.842.651.81~3.88<0.001
    脉管癌栓1.750.2073.995.763.87~8.59<0.001
    肿瘤分化程度-0.500.1218.680.600.48~0.76<0.001
    下载: 导出CSV 
    | 显示表格

    1 011例早期胃癌患者均获得术后随访,随访时间为43(0~135)个月,3年总生存率为97.32%。

    单因素分析结果显示:年龄、脉管癌栓、淋巴结转移是影响早期胃癌患者预后的相关因素(P<0.05);性别、BMI、胃癌家族史、吸烟史、饮酒史、肿瘤长径、肿瘤部位、肿瘤浸润深度、神经侵犯、肿瘤分化程度不是影响早期胃癌患者预后的相关因素(P>0.05)。见表3

    表  3  影响1 011例早期胃癌患者预后的单因素分析(例)
    Table  3.  Univariate analysis of prognosis in 1 011 patients with early gastric cancer (case)
    临床病理因素赋值例数3年总生存率(%)χ²值P
    性别
    156196.61.890.169
    045098.0
    年龄
    ≤60岁056398.95.950.015
    >60岁144897.3
    体质量指数
    ≤24 kg/m2070197.40.760.384
    >24 kg/m2131096.9
    胃癌家族史
    137696.61.690.193
    063599.3
    吸烟史
    135097.91.420.233
    066198.8
    饮酒史
    125898.81.090.297
    075398.4
    肿瘤长径
    ≤2 cm057797.50.140.708
    >2 cm143496.9
    肿瘤部位
    胃上部19097.40.570.752
    胃中部219398.1
    胃下部372898.2
    肿瘤浸润深度
    黏膜层044698.03.390.066
    黏膜下层156596.6
    脉管癌栓
    016697.85.260.022
    184594.4
    神经侵犯
    04598.80.300.587
    196695.1
    肿瘤分化程度
    低分化150197.74.210.122
    中分化229697.6
    高分化321495.6
    淋巴结转移
    077297.97.110.008
    123995.0
    下载: 导出CSV 
    | 显示表格

    多因素分析结果显示:年龄>60岁、淋巴结转移是影响早期胃癌患者预后的独立危险因素(P<0.05)。见表4。进一步分析结果显示:年龄>60岁与年龄≤60岁胃癌患者的3年总生存率分别为99.37%和94.66%,两者比较,差异有统计学意义(χ²=25.33,P<0.001)。见图1。有淋巴结转移与无淋巴结转移患者的3年总生存率分别为95.42%和97.92%,两者比较,差异有统计学意义(χ²=5.69,P=0.017)。见图2

    表  4  影响1 011例早期胃癌患者预后的多因素分析
    Table  4.  Multivariate analysis of prognosis in 1 011 patients with early gastric cancer
    临床病理因素回归系数标准误Wald值风险比95%可信区间P
    年龄>60岁2.250.5417.479.503.31~27.29<0.001
    淋巴结转移0.790.403.812.201.00~4.870.049
    下载: 导出CSV 
    | 显示表格
    图  1  年龄≤60岁和年龄>60岁早期胃癌患者术后总生存曲线
    Figure  1.  The postoperative overall survival curve in pati⁃ents with age ≤60 years and >60 years
    图  2  无淋巴结转移和有淋巴结转移早期胃癌患者术后总生存曲线
    Figure  2.  The postoperative overall survival curve in pati⁃ents without and with lymph node metastasis

    早期胃癌的主要治疗方法包括单纯外科手术和内镜下切除[89]。与外科手术切除比较,内镜下切除具有创伤小,术后生命质量高的优势,是早期胃癌的首选治疗方式[1013]。但内镜下切除由于无法清扫淋巴结,术后肿瘤复发风险高于外科手术切除[14]。因此,对于存在淋巴结转移的早期胃癌患者仍需施行外科手术以达到肿瘤根治性切除的效果。淋巴结转移也是影响早期胃癌患者预后的关键因素。本研究结果显示:有淋巴结转移患者3年总生存率低于无淋巴结转移患者,差异有统计学意义。因此,准确预测早期胃癌淋巴结转移风险,认识早期胃癌淋巴结的转移规律,有利于选择合适手术方式,提高治疗效果[15]

    本研究结果显示:早期胃癌的淋巴结转移率为23.640%(239/1 011)。这与其他研究相似[1618]。影响早期胃癌淋巴结转移的因素较多,其中脉管侵犯、肿瘤浸润深度、肿瘤大小是公认的影响因素[16,1922]。本研究多因素分析结果显示:肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是影响早期胃癌患者淋巴结转移的独立影响因素。这与其他研究者的结论相似[2325]。众多影响早期胃癌淋巴结转移的相关因素中,可用于术前评估的指标包含肿瘤长径、肿瘤部位和肿瘤浸润深度。术前术者可运用EUS和胃镜检查准确评估早期胃癌,指导选择合适的治疗方式[12,26]

    本研究结果显示:早期胃癌淋巴结转移主要集中在第一站淋巴结;不同肿瘤部位淋巴结转移率不同,且各组淋巴转移情况也不同。虽然不同部位早期胃癌的淋巴结转移模式不同,但均存在第3组淋巴结转移,宜作为清扫重点。金菲等[27]分析33例淋巴结转移早期胃癌患者的临床病理资料,结果显示:最常见的淋巴结转移部位为第3组淋巴结,其次为第4组淋巴结。这与本研究结果一致。D2淋巴结清扫术作为进展期胃癌的标准手术方式已在世界范围内推广,而早期胃癌的淋巴结转移主要集中在第一站淋巴结,多数早期胃癌患者可能过度淋巴结清扫。因此,笔者认为:需提高早期胃癌术前淋巴结转移诊断的准确率,在保证根治效果的前提下适当控制淋巴结清扫范围,提高患者生命质量。

    本研究结果显示:年龄>60岁、淋巴结转移是影响早期胃癌患者预后的独立危险因素。进一步分析结果显示:年龄>60岁与年龄≤60岁患者,有淋巴结转移与无淋巴结转移患者的3年总生存率比较,差异均有统计学意义。Li等[28]的研究结果显示:脉管癌栓是影响早期胃癌患者预后的独立危险因素,可作为术后辅助治疗的参考指标。年龄是胃癌患者预后的重要预测指标,不同年龄组胃癌患者的临床病理特征和预后因素存在显著差异[29]。淋巴结转移是影响胃癌患者术后预后的独立危险因素,可更好指导术后患者的诊断与治疗[30]。因此,笔者认为:如早期胃癌患者术后病理学检查结果示淋巴结转移,且年龄>60岁时,术后应行辅助化疗或放疗以延长其生存时间。

    综上,早期胃癌淋巴结转移率达23.640%,肿瘤长径、肿瘤部位、肿瘤浸润深度、脉管癌栓、肿瘤分化程度是早期胃癌患者淋巴结转移的独立影响因素;年龄>60岁、淋巴结转移是影响早期胃癌患者预后的独立危险因素。

    贺敬扬:构思和实施研究,分析数据并起草文章;李恩泽、于鹏程:参与收集和解读数据;张延强、胡灿:给予技术或资料支持;徐志远、程向东:获取研究经费;徐志远:对文章进行指导与批阅,给予支持性贡献
    所有作者均声明不存在利益冲突
    贺敬扬, 李恩泽, 于鹏程, 等. 早期胃癌淋巴结转移与预后影响因素分析[J]. 中华消化外科杂志, 2023, 22(9): 1093-1099. DOI: 10.3760/cma.j.cn115610-20230831-00050.

    http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20230831-23050(new)

  • 图  1   年龄≤60岁和年龄>60岁早期胃癌患者术后总生存曲线

    Figure  1.   The postoperative overall survival curve in pati⁃ents with age ≤60 years and >60 years

    图  2   无淋巴结转移和有淋巴结转移早期胃癌患者术后总生存曲线

    Figure  2.   The postoperative overall survival curve in pati⁃ents without and with lymph node metastasis

    表  1   影响1 011例早期胃癌患者淋巴结转移的单因素分析(例)

    Table  1   Univariate analysis of lymph node metastasis in 1 011 patients with early gastric cancer (case)

    临床病理因素赋值有淋巴结转移(239例)无淋巴结转移(772例)统计量值P
    性别
    1131430χ²=0.060.809
    0108342
    年龄
    ≤60岁0131432χ²=0.100.755
    >60岁1108340
    体质量指数
    ≤24 kg/m21162539χ²=0.560.511
    >24 kg/m2077233
    胃癌家族史
    192284χ²=0.230.633
    0147488
    吸烟史
    184266χ²=0.040.845
    0155506
    饮酒史
    167191χ²=1.040.308
    0172581
    肿瘤长径
    ≤2 cm099478χ²=31.29<0.001
    >2 cm1140294
    肿瘤部位
    胃上部1684χ²=15.82<0.001
    胃中部250143
    胃下部3183545
    肿瘤浸润深度
    黏膜内层053393χ²=61.11<0.001
    黏膜下层1186379
    脉管癌栓
    010264χ²=157.26<0.001
    1137708
    神经侵犯
    02124χ²=13.83<0.001
    1218748
    肿瘤分化程度
    低分化1125376Z=-2.450.014
    中分化288208
    高分化326188
    下载: 导出CSV

    表  2   影响1 011例早期胃癌患者淋巴结转移的多因素分析

    Table  2   Multivariate analysis of lymph node metastasis in 1 011 patients with early gastric cancer

    临床病理因素回归系数标准误Wald优势比95%可信区间P
    肿瘤长径0.590.1712.151.801.29~2.50<0.001
    肿瘤部位0.400.157.101.491.11~2.000.008
    肿瘤浸润深度0.970.2024.842.651.81~3.88<0.001
    脉管癌栓1.750.2073.995.763.87~8.59<0.001
    肿瘤分化程度-0.500.1218.680.600.48~0.76<0.001
    下载: 导出CSV

    表  3   影响1 011例早期胃癌患者预后的单因素分析(例)

    Table  3   Univariate analysis of prognosis in 1 011 patients with early gastric cancer (case)

    临床病理因素赋值例数3年总生存率(%)χ²值P
    性别
    156196.61.890.169
    045098.0
    年龄
    ≤60岁056398.95.950.015
    >60岁144897.3
    体质量指数
    ≤24 kg/m2070197.40.760.384
    >24 kg/m2131096.9
    胃癌家族史
    137696.61.690.193
    063599.3
    吸烟史
    135097.91.420.233
    066198.8
    饮酒史
    125898.81.090.297
    075398.4
    肿瘤长径
    ≤2 cm057797.50.140.708
    >2 cm143496.9
    肿瘤部位
    胃上部19097.40.570.752
    胃中部219398.1
    胃下部372898.2
    肿瘤浸润深度
    黏膜层044698.03.390.066
    黏膜下层156596.6
    脉管癌栓
    016697.85.260.022
    184594.4
    神经侵犯
    04598.80.300.587
    196695.1
    肿瘤分化程度
    低分化150197.74.210.122
    中分化229697.6
    高分化321495.6
    淋巴结转移
    077297.97.110.008
    123995.0
    下载: 导出CSV

    表  4   影响1 011例早期胃癌患者预后的多因素分析

    Table  4   Multivariate analysis of prognosis in 1 011 patients with early gastric cancer

    临床病理因素回归系数标准误Wald值风险比95%可信区间P
    年龄>60岁2.250.5417.479.503.31~27.29<0.001
    淋巴结转移0.790.403.812.201.00~4.870.049
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-08-30
  • 网络出版日期:  2024-06-24
  • 刊出日期:  2023-09-19

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