作者：唐维，刘一帆，李广华，王志雄

单位：中山大学附属第一医院 胃肠外科中心， 广东 广州 510080

Authors: Tang Wei，Liu Yifan，Li Guanghua，Wang Zhixiong

Unit: Department of Gastrointestinal Surgery，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，Guangdong，China

摘要：

目的 分析胃癌第8p组淋巴结转移与临床病理参数的联系，探讨该组淋巴结转移的危险因素及预后。方法 回顾性分析中山大学附属第一医院胃肠外科中心接受手术治疗的胃癌患者资料，探讨第8p组淋巴结转移与临床病理参数的关系，比较第8p组淋巴结转移阳性患者(转移阳性组)与阴性患者(转移阴性组)的生存，使用Cox比例风险模型研究第8p组淋巴结转移与患者预后的关系，多因素Logistic回归分析探讨影响第8p组淋巴结转移的危险因素。结果 共653例胃癌患者被纳入研究，第8p组淋巴结的转移率为6.43%(42/653)。转移阳性组中，术前腹部增强计算机断层扫描(CT)提示胃周淋巴结转移的患者比例明显高于转移阴性组(95.2%比58.8%)，且差异有统计学意义(P<0.001)；转移阳性组中T4肿瘤(78.5%)、TNMⅢ期(95.2%)比例高于阴性组，差异有统计学意义(P<0.001)；转移阳性组患者的5年生存率和中位生存期分别为52.3%和77个月，预后较转移阴性组差；多因素分析显示第8p组淋巴结转移是影响患者预后的独立危险因素(HR=2.86,95%CI:1.41～5.83,P=0.004)；多因素Logistic回归分析显示肿瘤浸润浆膜层或邻近组织(T4期)(OR=3.38,95%CI:1.64～7.69,P=0.002)、术前腹部增强CT提示胃周淋巴结转移(OR=11.52,95%CI:3.47～71.42,P<0.001)是胃癌患者发生第8p组淋巴结转移的独立危险因素。结论 第8p组淋巴结转移是胃癌患者疾病进展的标志，第8p组淋巴结转移阳性患者的预后较转移阴性者差，当术前的腹部增强CT提示胃周淋巴结存在转移、肿瘤分期达T4期时，第8p组淋巴结更容易发生转移，建议在术中将第8p组淋巴结一并清扫。 

关键词：胃癌淋巴结转移； 第8p 组淋巴结； 生存分析； 危险因素； 胃周淋巴结

Abstract：

Objective To analyze the clinicopathological characteristics and prognosis of No.8p lymph nodes metastasis in gastric cancer，and to explore the risk factors of No.8p lymph nodes metastasis. Method The data of patients with gastric cancer who underwent surgery in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed to explore the relationship between No.8p lymph nodes metastasis and clinicopathological parameters，and to compare the survival of patients with positive and negative No.8p lymph nodes metastasis. Cox proportional hazard model was used to study the relationship between No.8p lymph nodes metastasis and prognosis. Multivariate logistic regression was used to explore the risk factors of No.8p lymph nodes metastasis. Result A total of 653 patients with gastric cancer were enrolled in the study. The rate of metastasis in No.8p lymph nodes was 6.43%（42/653）. In No.8p -positive group，the proportion of patients with perigastric lymph node metastasis in preoperative abdominal enhanced CT was significantly higher than that in No.8p-negative group （95.2% vs 58.8%），and the difference was statistically significant （P<0.001）. The proportion of T4 tumor （78.5%） and TNM stage Ⅲ （95.2%） in No.8p-positive group was significantly higher than that in No.8p-negative group （P<0.001）. The 5-year survival rate and median survival time of patients with No.8p metastasis was 52.3% and 77 months，respectively，and the prognosis was worse than that of patients in the No.8p -negative group. Multivariate analysis showed that the metastasis in No.8p lymph nodes was an independent risk factor for prognosis （HR =2.86，95%CI:1.41 -5.83，P =0.004）. Multivariate logistic regression analysis showed that tumor invasion of serosa or adjacent structures （T4） （OR=3.38，95%CI:1.64 -7.69，P =0.002） and preoperative abdominal enhanced CT suggested perigastric lymph node metastasis （OR=11.52，95%CI: 3.47-71.42，P<0.001） were independent risk factors for metastasis in No.8p lymph node in gastric cancer. Conclusion No.8p lymph node metastasis is a sign of disease progression in patients with gastric cancer. The prognosis of patients with No.8p lymph node metastasis is worse than that of patients without No.8p lymph node metastasis. When preoperative abdominal enhanced CT indicates that there is metastasis in perigastric lymph nodes and the tumor reaches T4，metastasis in No.8p lymph node is more likely to occur，which suggested that No.8p lymph nodes should be dissected during operation.

Key Words:  Lymph node metastasis in gastric cancer; No.8p lymph nodes; Survival analysis; Risk factors; Perigastric lymph nodes