早期胃癌淋巴结转移相关因素分析及腹腔镜D2根治术与内镜黏膜下剥离术临床疗效的回顾性队列研究

孟祥勇; 陈志国; 王梓义; 杨佳; 陈文生

doi:10.16016/j.2097-0927.202310044

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早期胃癌淋巴结转移相关因素分析及腹腔镜D2根治术与内镜黏膜下剥离术临床疗效的回顾性队列研究

临床医学 | 更新时间：2026-01-09

- 早期胃癌淋巴结转移相关因素分析及腹腔镜D2根治术与内镜黏膜下剥离术临床疗效的回顾性队列研究
- Related factors of lymph node metastasis in early gastric cancer and clinical efficacy of laparoscopic D2 radical resection versus endoscopic submucosal dissection: a retrospective cohort study
- 陆军军医大学学报 2024年46卷第9期页码：1041-1046
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院消化内科
- 作者简介：
  
  [陈文生，E-mail：2303141134@qq.comCHEN Wensheng, E-mail: 2303141134@qq.com
- 基金信息：
  
  利益冲突所有作者声明无利益冲突;作者贡献声明孟祥勇：数据统计分析，文章撰写；陈志国：数据整理；王梓义、杨佳：数据分析；陈文生：研究指导、论文审阅
- DOI：10.16016/j.2097-0927.202310044
  中图分类号： R181.32;R730.56;R735.2
- 收稿：2023-10-13，
  
  修回：2024-03-06，
  
  纸质出版：2024-05-15
- 稿件说明：
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孟祥勇, 陈志国, 王梓义, 等. 早期胃癌淋巴结转移相关因素分析及腹腔镜D2根治术与内镜黏膜下剥离术临床疗效的回顾性队列研究[J]. 陆军军医大学学报, 2024,46(9):1041-1046.

Xiangyong MENG, Zhiguo CHEN, Ziyi WANG, et al. Related factors of lymph node metastasis in early gastric cancer and clinical efficacy of laparoscopic D2 radical resection versus endoscopic submucosal dissection: a retrospective cohort study[J]. Journal of Army Medical University, 2024, 46(9): 1041-1046.
孟祥勇, 陈志国, 王梓义, 等. 早期胃癌淋巴结转移相关因素分析及腹腔镜D2根治术与内镜黏膜下剥离术临床疗效的回顾性队列研究[J]. 陆军军医大学学报, 2024,46(9):1041-1046. DOI： 10.16016/j.2097-0927.202310044.

Xiangyong MENG, Zhiguo CHEN, Ziyi WANG, et al. Related factors of lymph node metastasis in early gastric cancer and clinical efficacy of laparoscopic D2 radical resection versus endoscopic submucosal dissection: a retrospective cohort study[J]. Journal of Army Medical University, 2024, 46(9): 1041-1046. DOI： 10.16016/j.2097-0927.202310044.

摘要

目的

探究早期胃癌淋巴结转移的相关因素，分析腹腔镜D2根治术与内镜黏膜下剥离术(endoscopic submucosal dissection

ESD)的临床疗效差异。

方法

采用回顾性队列研究方法，选择2018年6月至2022年6月于我院进行手术治疗的404例早期胃癌患者作为研究对象，根据手术方法的不同将患者分为腹腔镜组(271例)和ESD组(133例)。比较不同临床特征患者的淋巴结转移情况，多因素Logistic回归分析影响早期胃癌患者淋巴结转移的因素；统计符合ESD绝对适应证和扩大适应证患者的淋巴结转移率；Kaplan-Meier法比较早期胃癌患者ESD与腹腔镜D2根治术的远期疗效；采用分层回归分析探索早期胃癌患者手术方式与远期疗效间的关系。

结果

404例早期胃癌患者中，淋巴结转移率为12.38%(50/404)。单因素分析结果显示，合并溃疡、肿瘤病理类型、病理分化程度等7个临床特征与淋巴结转移有关；多因素Logistic回归分析结果显示，肿瘤分化程度为低分化、肿瘤浸润深度为SM是影响早期胃癌淋巴结转移的相关因素；404例患者总体生存率为96.29%(389/404)，腹腔镜组生存率(96.31%)与ESD组生存率(96.24%)差异无统计学意义；符合ESD绝对适应证而行腹腔镜D2根治术与ESD治疗的5年生存率分别为96.00%和96.55%，差异无统计学意义；符合ESD扩大适应证而行腹腔镜D2根治术与ESD治疗的5年生存率分别为94.74%和91.67%，差异无统计学意义。经分层回归分析调整病变大小、病理分化程度、肿瘤浸润深度等临床特征后，早期胃癌患者手术方式与远期疗效依然相关(

=1.173，

=0.003)。

结论

肿瘤浸润深度、分化程度与早期胃癌患者淋巴结转移密切相关。符合ESD绝对适应证和扩大适应证患者行腹腔镜D2根治术与ESD治疗的效果相当。

Abstract

Objective

To explore the related factors of lymph node metastasis in early gastric cancer and to analyze the clinical efficacy between laparoscopic D2 radical resection and endoscopic submucosal dissection (ESD).

Methods

A retrospective cohort study was conducted on 404 patients with early gastric cancer undergoing surgical treatment in our hospital from June 2018 to June 2022 were recruited in this study. According to their surgical treatment

they were divided into laparoscopy group (

=271) and ESD group (

=133). The lymph node metastases were comp

ared in the patients with different clinical features

and the factors affecting lymph node metastasis were analyzed with multivariate logistic regression analysis. The lymph node metastasis rate of patients with absolute and expanded indications of ESD was calculated. Kaplan-Meier survival analysis was used to compare the long-term efficacy of ESD and laparoscopic D2 radical resection in these patients. Stratified regression analysis was applied to explore the relationship between surgical methods and long-term outcome in them.

Results

In the 404 patients with early gastric cancer

the rate of lymph node metastasis was 12.38% (50/404). Univariate analysis showed that 7 clinical features

such as ulcer

tumor pathological features and pathological differentiation

were related to lymph node metastasis. Multivariate logistic regression analysis revealed that low differentiation and tumor infiltration depth of submucous membrane (SM) were related factors affecting lymph node metastasis in early gastric cancer. The overall survival rate was 96.29% (389/404) in the 404 patients

96.31% in the laparoscopic group and 96.24% in the ESD group

and no statistical difference was seen between the 2 groups (

0.05). There was no obvious difference in 5-year survival rate between the patients who met the absolute indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment (96.00%

96.55%)

and between those who were in accordance with the expanded indications for ESD and underwent laparoscopic D2 radical surgery and those receiving ESD treatment (94.74%

91.67%). After adjusting the clinical features such as lesion size

pathological differentiation and depth of tumor invasion by stratified regression analysis

the mode of operation for early gastric cancer was still correlated with the long-term efficacy (β=1.173

=0.003).

Conclusion

The depth of tumor infiltration and differentiation are closely related to lymph node metastasis in early gastric cancer patients. The efficacy of laparoscopic D2 radical surgery on the patients with absolute and expanded indications for ESD is comparable to that of ESD treatment.

关键词

Keywords

references

WANG F H, ZHANG X T, TANG L, et al . The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer, 2023[J ] . Cancer Commun, 2024, 44(1): 127-172. DOI: 10.1002/cac2.12516.

LEI Z N, TENG Q X, TIAN Q, et al . Signaling pathways and therapeutic interventions in gastric cancer[J ] . Signal Transduct Target Ther, 2022, 7(1): 358. DOI: 10.1038/s41392-022-01190-w.

IKENOYAMA Y, HIRASAWA T, ISHIOKA M, et al . Detecting early gastric cancer: comparison between the diagnostic ability of convolutional neural networks and endoscopists[J ] . Dig Endosc, 2021, 33(1): 141-150. DOI: 10.1111/den.13688.

OGATA Y, HATTA W, OHARA Y, et al . Predictors of early and late mortality after the treatment for early gastric cancers[J ] . Dig Endosc, 2022, 34(4): 816-825. DOI: 10.1111/den.14172.

WANG Z Y, XIA Q H, LI A S, et al . Comparison of the effects of endoscopic submucosal dissection and laparoscopic distal radical surgery on the rehabilitation and quality of life of patients with early gastric cancer[J ] . Am J Transl Res, 2023, 15(3): 2183-2190.

PARK S H, YOON H M, RYU K W, et al . Risks and benefits of additional surgery for early gastric cancer in the upper third of the stomach meeting non-curative resection criteria after endoscopic submucosal dissection[J ] . World J Surg Oncol, 2022, 20(1): 311. DOI: 10.1186/s12957-022-02780-2.

KUROKI K, OKA S, TANAKA S, et al . Clinical significance of endoscopic ultrasonography in diagnosing invasion depth of early gastric cancer prior to endoscopic submucosal dissection[J ] . Gastric Cancer, 2021, 24(1): 145-155. DOI: 10.1007/s10120-020-01100-5.

ONO H, YAO K S, FUJISHIRO M, et al . Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition)[J ] . Dig Endosc, 2021, 33(1): 4-20. DOI: 10.1111/den.13883.

YIM K, JANG W M, LEE S H. Modified tumor budding as a better predictor of lymph node metastasis in early gastric cancer: possible real-world applications[J]. Cancers, 2021, 13(14): 3405. DOI: 10.3390/cancers13143405.

WEI J T, ZHANG Y N, LIU Y Q, et al . Construction and validation of a risk-scoring model that preoperatively predicts lymph node metastasis in early gastric cancer patients[J ] . Ann Surg Oncol, 2021, 28(11): 6665-6672. DOI: 10.1245/s10434-021-09867-2.

CAI F L, DONG Y P, WANG P L, et al . Risk assessment of lymph node metastasis in early gastric cancer: establishment and validation of a seven-point scoring model[J ] . Surgery, 2022, 171(5): 1273-1280. DOI: 10.1016/j.surg.2021.10.049.

宋立强, 崔昊, 梁文全, 等. 早期胃癌伴淋巴结转移患者远期预后的影响因素分析[J]. 腹腔镜外科杂志, 2023, 28(1): 41-45. DOI: 10.13499/j.cnki.fqjwkzz.2023.01.041.

SONG L Q, CUI H, LIANG W Q, et al . Prognostic factors of early gastric cancer patients with lymph node metastasis[J ] . J Laparosc Surg, 2023, 28(1): 41-45. DOI: 10.13499/j.cnki.fqjwkzz.2023.01.041.

CHEN J N, WANG Q W, ZHANG Q W, et al . Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital[J ] . Surg Endosc, 2021, 35(4): 1558-1565. DOI: 10.1007/s00464-020-07532-5.

王权, 夏明杰. 早期胃癌淋巴结转移特征与危险因素[J]. 中国实用外科杂志, 2022, 42(10): 1107-1110. DOI: 10.19538/j.cjps.issn1005-2208.2022.10.06.

WANG Q, XIA M J. Characteristics and risk factors of lymph node metastasis in early gastric cancer[J]. Chin J Pract Surg, 2022, 42(10): 1107-1110. DOI: 10.19538/j.cjps.issn1005-2208.2022.10.06.

蒋潇洒, 杨倩, 高旭, 等. 早期胃癌淋巴结转移的相关危险因素分析及预测模型的建立[J]. 胃肠病学和肝病学杂志, 2022, 31(3): 310-315. DOI: 10.3969/j.issn.1006-5709.2022.03.015.

JIANG X S, YANG Q, GAO X, et al . Analysis of risk factors and establishment of predictive model for lymph node metastasis in early gastric cancer[J ] . Chin J Gastroenterol Hepatol, 2022, 31(3): 310-315. DOI: 10.3969/j.issn.1006-5709.2022.03.015.

CHOI S, SONG J H, LEE S J, et al . Lymphovascular invasion: traditional but vital and sensible prognostic factor in early gastric cancer[J ] . Ann Surg Oncol, 2021, 28(13): 8928-8935. DOI: 10.1245/s10434-021-10224-6.

武颖超, 蔡云龙, 戎龙, 等. 早期胃癌淋巴结转移规律及内镜黏膜下剥离术治疗早期胃癌的疗效评价[J]. 北京大学学报(医学版), 2020, 52(6): 1093-1097. DOI: 10.19723/j.issn.1671-167X.2020.06.017.

WU Y C, CAI Y L, RONG L, et al . Characteristics of lymph node metastasis and evaluating the efficacy of endoscopic submucosal dissection in early gastric cancer[J ] . J Peking Univ Health Sci, 2020, 52(6): 1093-1097. DOI: 10.19723/j.issn.1671-167X.2020.06.017.

ZHANG M Q, DING C, XU L, et al . A nomogram to predict risk of lymph node metastasis in early gastric cancer[J ] . Sci Rep, 2021, 11(1): 22873. DOI: 10.1038/s41598-021-02305-z.

GUO X Y, GU J, XUE A W, et al . Loss of GNE predicts lymph node metastasis in early gastric cancer[J ] . Cells, 2022, 11(22): 3624. DOI: 10.3390/cells11223624.

QIAN M, SHENG Y, WU M, et al . Comparison between endoscopic submucosal dissection and surgery in patients with early gastric cancer[J ] . Cancers, 2022, 14(15): 3603. DOI: 10.3390/cancers14153603.

NA J E, LEE H, MIN Y W, et al . Clinical feasibility and oncologic safety of primary endoscopic submucosal dissection for clinical submucosal invasive early gastric cancer[J ] . J Cancer Res Clin Oncol, 2021, 147(10): 3051-3061. DOI: 10.1007/s00432-021-03581-y.

YANG H J, KIM J H, KIM N W, et al . Comparison of long-term outcomes of endoscopic submucosal dissection and surgery for undifferentiated-type early gastric cancer meeting the expanded criteria: a systematic review and meta-analysis[J ] . Surg Endosc, 2022, 36(6): 3686-3697. DOI: 10.1007/s00464-022-09126-9.

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