作者：熊兰，龙元元，崔贤杰

单位：隆昌市人民医院 内五科， 四川 隆昌 642150

Authors: Xiong Lan，Long Yuanyuan，Cui Xianjie

Unit: The Fifth Department of Internal Medicine，Longchang People's Hospital，Longchang 642150，Sichuan，China

摘要：

目的 通过对胃黏膜内癌淋巴结转移有关的高危因素探索，为临床疗法提供理论基础。方法 回顾性分析隆昌市人民医院2012年1月至2021年12月行根治性胃癌手术的胃黏膜内癌患者387例。患者均于术前常规实施胃镜、超声等影像学检查，病理活检等，并于术后取病理标本再次明确诊断。对淋巴结转移的发生率进行统计，通过多因素Logistic回归算法，对胃黏膜内癌淋巴结转移相关的危险因素进行探讨。结果 纳入的387例胃黏膜内癌患者中，有24例（6.20%）合并淋巴结转移。淋巴结转移组肿瘤直径>2.0 cm、病理无分化、浸入到黏膜肌层、伴脉管癌栓塞发生率均比非淋巴结转移组高（P<0.05）。多因素Logistic回归分析表明，胃黏膜内癌淋巴结转移的高危因子主要有肿瘤直径>2.0 cm、肿瘤未分化、黏膜肌层浸润、伴脉管癌栓等。ROC曲线对胃黏膜内癌淋巴结转移的预测情况进行了评估，其中肿瘤大小对淋巴结转移的预测准确度最高，特异度为84.6%，敏感度为48.5%，约登指数0.33,AUC=0.898 (95%CI:0.846～0.936)，临界值>1.84 cm。结论 在胃黏膜内癌的治疗中，分析淋巴结转移的相关危险因素，对科学、合理制定治疗方案具有重要的指导意义。 

关键词：黏膜内癌； 早期胃癌； 淋巴结转移； 病理学； 危险因素

Abstract：

Objective To explore the high risk factors of lymph node metastasis in gastric mucosal carcinoma，and to provide theoretical basis for clinical treatment. Method According to the retrospective requirements，387 patients with gastric mucosal carcinoma who underwent radical gastrectomy in our hospital from January 2012 to December 2021 were selected. Patients were routinely subjected to imaging examinations such as gastroscopy and ultrasound，pathological biopsy，etc. before surgery，and pathological specimens were taken after surgery to clarify the diagnosis again. The frequency of lymph node metastasis was counted ，and the multivariate logistic regression algorithm was used to explore the related risk factors of lymph node metastasis in gastric mucosal carcinoma. Result Among 387 patients with gastric cancer，24 （6.20%） had lymph node metastasis. In the lymph node metastasis group，the tumor diameter was greater than 2.0 cm，pathologically undifferentiated，infiltrating into the muscularis mucosae，and the incidence of vascular tumor embolism were higher than those in the non-lymph node metastasis group （P<0.05）. Logistic multi-factor calculation results showed that the high-risk factors of lymph node metastasis of gastric intramucosal cancer mainly included tumor diameter >2.0 cm，undifferentiated tumor，muscular mucosal infiltration and vascular tumor thrombus. ROC curve evaluated the prediction of lymph node metastasis of gastric intramucous carcinoma, among which tumor size had the highest prediction accuracy for lymph node metastasis, with specificity of 84.6%, sensitivity of 48.5%, Yoden index of 0.33, AUC=0.898 (95% CI: 0.846~0.936), and critical value>1.84 cm. Conclusion In the treatment of gastric intramucosal carcinoma ，the analysis of high risk factors related to lymph node metastasis has important guiding significance for scientific and rational formulation of treatment plans.

Key Words:  Intramucosal carcinoma; Early gastric cancer; Lymph node metastasis; Pathology; Risk factors