【摘要】 目的探讨不同部位胃癌的临床病理特点、淋巴结转移规律及预后的异同,为进一步合理选择治疗方案提供线索。方法选取1980年1月～2005年6月在中国医科大学附属第一医院胃肠肿瘤外科行R0手术治疗的病理资料齐全的胃癌患者,按肿瘤部位进行分类,分别总结其临床病理特征、淋巴结转移规律及预后情况并进行对比研究。结果在性别、年龄、病灶大小、大体类型、pT分期方面不同部位胃癌差异有统计学意义。不同部位胃癌淋巴结转移分布规律不同。淋巴结转移与病灶大小、大体类型、pT分期以及是否有淋巴管癌栓有关(P<0.05),不同胃癌部位的淋巴结转移率差异无统计学意义。生存分析显示,上部癌的总体预后最差,与中、下部癌相比差异有统计学意义(P=0.004、0.000);不同部位胃癌预后影响因素:肿瘤pN分期、pT分期为胃上部癌的独立预后影响因素;肿瘤pN分期、pT分期、病灶大小为胃中、下部癌的独立预后影响因素。结论胃上、中、下部癌临床病理特征显著不同;胃周淋巴结转移分布差异明显;不同胃癌部位的淋巴结转移率无统计学差异;与胃中、下部癌相比,上部癌生物学行为特征不良,预后较差。更多还原

【Abstract】 Objective To investigate both the similarities and differences in the clinical pathological features,lymphatic metastasis regularity and prognosis of gastric cancers at different locations,and help to find optimized therapies.Methods Patients who were operated with R0 surgeries in NO.1 Affiliated Hospital of CMU from January 1980 to June 2005 and who had completed pathological records were selected,and divided into groups by their tumor locations.Pathological features,lymphatic metastasis regularity and prognosis of each group were collected and comparisons were performed among the groups.Results There were no statistic differences among the gastric caners at different locations in gender,age,lesion size,subtypes and pT classification.Gastric cancers at different locations varied in lymphatic metastasis regu larity.The lymphatic metastasis was related to lymphatic metastasis,lesion size,subtypes,pT classification and lymphatic embolus(P<0.05),and that there was no statistic difference in lymphatic metastasis rates among gastric cancers at dif ferent locations.The survival curves showed that the general prognosis of upper part cancer was the worst,and there was statistic difference between it and those of the middle and lower part cancer(P=0.004,0.000);the influencing factors to gastric cancers at different locations were performed :tumor pN classification and pT classification were the influencing factors to the independent prognosis of upper part gastric cancer;tumor pN classification,pT classification,lesion size were influencing factors to middle and lower part gastric cancers.Conclusion There are significant differences in clinical features among upper,middle,lower part gastric cancer and in the distributions of lymph gland metastasis around the stomach;there is no statistic difference among the lymph gland metastasis at different cancer locations.Compares with middle and lower part cancer,the biological behaviors of upper part cancer are bad and prognosis is unsatisfactory.更多还原