【摘要】 目的探讨淋巴结转移率（metastasis lymph nodes ratio,MLR）在评估T_4a期胃癌患者预后中的应用价值。方法回顾性研究215例胃癌患者,分析MLR和淋巴结转移个数与检出淋巴结总数间的关系,并比较二者在预测胃癌患者术后生存的准确性。结果淋巴结转移率与检出淋巴结总数无相关性（r=0.017,P> 0.05）,淋巴结转移个数与检出淋巴结总数具有相关性（r=0.264,P <0.05）。单因素分析表明,影响T_4a胃癌患者预后的因素包括:肿瘤分化程度、脉管侵犯、淋巴结分期及淋巴结转移率分期;多因素COX比例风险回归模型分析,MLR分期是独立预后因素。两种分期在预测患者术后5年内死亡的ROC曲线下面积差异无统计学意义（P> 0.05）。结论淋巴结转移率分期不受淋巴结总数影响,是影响T_4a期胃癌患者预后的独立因素,是一个相对稳定的评估方式,可以考虑把淋巴结转移率分期作为评估预后重要工具之一。更多还原

【Abstract】 Objective To evaluate the outcome of metastasis lymph nodes ratio（MLR） in gastric cancer patients with T_4a stage after curative resection. Methods A retrospective study of 215 patients with gastric cancer was conducted to analyze the relationship between MLR, the number of lymph node metastases and the total number of lymph nodes detected. And the accuracy of the two in predicting postoperative survival of patients with gastric cancer were campared. Results The metastatic lymph node ratio was not correlated with the total number of lymph nodes dissected（r=0.017, P > 0.05）, whereas the number of metastatic lymph nodes was（r =0.264, P < 0.05）. Univariate analysis revealed that histological grade, status of lymphovascular, number of metastatic lymph nodes and metastatic lymph nodes ratio have significant impact on survival. However, Multivariate COX proportional hazards regression analysis showed that MLR staging was an independent prognostic factor. There was no significant difference in the area under the ROC curve between the two stages（P > 0.05）. Conclusion The metastatic lymph node ratio is an independent prognostic factor regardless of the examined number of lymph nodes. In predicting the prognosis of gastric cancer, the staging system based on the metastatic lymph node ratio is more reliable than the current pN staging. We propose that the MLR staging can be recommended as an applicable parameter for lymph node involvement of gastric cancer.更多还原