不同部位胃腺癌第12a组淋巴结转移的危险因素分析

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不同部位胃腺癌第12a组淋巴结转移的危险因素分析

论著 | 更新时间：2025-12-31

- 不同部位胃腺癌第12a组淋巴结转移的危险因素分析
- Analysis of group 12a lymph node metastasis at different sites of gastric adenocarcinoma and its risk factors
- 中国癌症杂志 2023年33卷第6期页码：597-604
- 作者机构：
  
  1. 河南省人民医院胃肠外科，河南郑州 450003
  2. 哈尔滨医科大学基础医学院，黑龙江哈尔滨 150081
- 作者简介：
  
  [ "杜书祥（ROCID：0000-0002-2364-2028），硕士研究生在读。" ]
  吴刚（ROCID：0000-0002-8007-8793），博士，主任医师。
- 基金信息：
  
  河南省科技攻关项目(SBGJ202102028)
- DOI：10.19401/j.cnki.1007-3639.2023.06.007
  中图分类号： R735.2
- 收稿：2022-08-10，
  
  修回：2023-03-14，
  
  纸质出版：2023-06-30
- 稿件说明：
移动端阅览
杜书祥, 赵英志, 张雪涛, 等. 不同部位胃腺癌第12a组淋巴结转移的危险因素分析[J]. 中国癌症杂志, 2023,33(6):597-604.

Shuxiang DU, Yingzhi ZHAO, Xuetao ZHANG, et al. Analysis of group 12a lymph node metastasis at different sites of gastric adenocarcinoma and its risk factors[J]. China Oncology, 2023, 33(6): 597-604.
杜书祥, 赵英志, 张雪涛, 等. 不同部位胃腺癌第12a组淋巴结转移的危险因素分析[J]. 中国癌症杂志, 2023,33(6):597-604. DOI： 10.19401/j.cnki.1007-3639.2023.06.007.

Shuxiang DU, Yingzhi ZHAO, Xuetao ZHANG, et al. Analysis of group 12a lymph node metastasis at different sites of gastric adenocarcinoma and its risk factors[J]. China Oncology, 2023, 33(6): 597-604. DOI： 10.19401/j.cnki.1007-3639.2023.06.007.

摘要

背景与目的：

胃癌中肝十二指肠韧带内（沿肝动脉）淋巴结（第12a组淋巴结）转移规律尚不明确，其清扫指征仍有争议，目前缺乏大样本的相关临床研究数据。本研究通过观察不同部位胃癌第12a组淋巴结的转移率，探讨不同部位胃癌第12a组淋巴结转移的危险因素。

方法：

对河南省人民医院2016年5月—2021年7月胃外科收治的1 112例胃癌患者的病历资料进行回顾性分析，根据肿瘤位置分为胃上部癌（561例）、胃体癌（224例）、胃窦癌（327例），记录不同部位胃癌患者第12a组淋巴结转移率。采用

χ

2

检验或Fisher确切概率检验比较不同部位胃癌患者第12a组淋巴结转移与临床病理学特征的关系，通过多因素logistic回归分析不同部位胃癌患者第12a组淋巴结转移的危险因素。

结果：

1 112例胃癌患者中72例发生第12a组淋巴结转移，整体转移率为6.5%。561例胃上部癌中有25例发生第12a组淋巴结转移，转移率为4.5%。224例胃体癌中有17例第12a组淋巴结为阳性，转移率为7.6%；327例胃窦癌中有30例第12a组淋巴结为阳性，转移率为9.2%。以第12a组淋巴结是否转移为因变量，以单因素分析差异有统计学意义的指标为自变量，纳入模型进行多因素logistic回归分析。结果显示，肿瘤直径（OR = 3.122，95% CI：2.896 ~ 3.366，

P

<

0.001）、T分期（OR = 2.406，95% CI：1.705 ~ 3.396，

P

<

0.001）及TNM分期（OR = 7.91，95% CI：4.755 ~ 13.160，

P

<

0.001）是胃上部癌患者第12a组淋巴结转移的危险因素；肿瘤直径（OR = 2.757，95% CI：2.495 ~ 3.047，

P

<

0.001）、T分期（OR = 3.298，95% CI：2.346 ~ 4.638，

P

<

0.001）及脉管神经侵犯（OR = 1.839，95% CI：1.368 ~ 2.473，

P

<

0.001）是胃体癌患者第12a组淋巴结转移的危险因素；体重指数（body mass index，BMI）（OR = 1.098，95% CI：1.023 ~ 1.178，

P

= 0.010）、肿瘤直径（OR = 2.865，95% CI：1.778 ~ 4.616，

P

<

0.001）、T分期（OR = 13.497，95% CI：8.363 ~ 21.783，

P

<

0.001）及TNM分期（OR = 3.806，95% CI：3.113 ~ 4.653，

P

<

0.001）是胃窦癌患者第12a组淋巴结转移的危险因素。

结论：

第12a组淋巴结总转移率较低；肿瘤大小、浸润深度、肿瘤分期是胃癌第12a组淋巴结转移的独立危险因素，同时神经血管侵犯是胃体癌的独立危险因素；胃体、胃窦癌需要常规清扫第12a组淋巴结；胃上部癌第12a组淋巴结转移率低，不需要常规清扫，但当直径≥6 cm、肿

瘤浸润深度较深（T

3

~ T

4

）、肿瘤分期较晚（Ⅲ ~ Ⅳ）时则需要清扫第12a组淋巴结。

Abstract

Background and purpose:

It is not clear that the pattern of lymph node (group 12a) metastasis within the hepatoduodenal ligament (along the hepatic artery) in gastric cancer

its indications for dissection are still controversial

and there is a lack of relevant clinical study data from large samples. This study investigated the risk factors of lymph node group 12a metastasis in gastric cancer at different sites by observing the lymph node metastasis rate.

Methods:

The medical records of 1 112 gastric cancer patients admitted to the Department of Gastric Surgery in Henan Provincial People’s Hospital from May 2016 to July 2021 were retrospectively analyzed. According to tumor location

they were divided into upper gastric cancer (561 cases)

gastric body cancer (224 cases) and gastric antrum cancer (327 cases). The lymph node metastasis rate of group 12a in patients with different parts of gastric cancer was recorded. The c2 test and Fisher’s exact probability test were used to compare the relationship between group 12a lymph node metastasis and clinicopathological features in patients with gastric cancer at different sites. Multivariate logistic regression analysis was used to analyze the risk factors of group 12a lymph node metastasis in patients with gastric cancer at different locations.

Results:

Group 12a lymph node metastasis occurred in 72 of 1 112 gastric cancer patients

and the overall metastatic rate was 6.5%. Among the 561 cases of upper gastric cancer

25 cases developed group 12a lymph node metastasis

and the metastatic rate was 4.5%. Of the 224 patients with gastric body cancer

17 cases were positive in group 12a lymph nodes

and the metastasis rate was 7.6%. Among the 327 cases of gastric antrum cancer

30 cases were positive in group 12a lymph nodes

and the metastatic rate was 9.2%. Taking the lymph nod

e metastasis in group 12a as the dependent variable

and taking the indicators with statistical significance in univariate analysis as independent variables

they were included in the model for multivariate logistic regression analysis. The results showed that tumor diameter (OR=3.122

95% CI: 2.896-3.366

P

<

0.001)

T stage (OR=2.406

95% CI: 1.705-3.396

P

<

0.001)

TNM stage (OR=7.910

95% CI: 4.755-13.160

P

<

0.001) were risk factors for lymph node metastasis in group 12a of upper gastric cancer patients. Tumor diameter (OR=2.757

95% CI: 2.495-3.047

P

<

0.001)

T stage (OR=3.298

95% CI: 2.346-4.638

P

<

0.001)

vascular nerve invasion (OR=1.839

95% CI: 1.368-2.473

P

<

0.001) were risk factors for lymph node metastasis in group 12a of patients with gastric body cancer. Body mass index (BMI) (OR=1.098

95% CI: 1.023-1.178

P

=0.010)

tumor diameter (OR=2.865

95% CI: 1.778-4.616

P

<

0.001)

T stage (OR=13.497

95% CI: 8.363-21.783

P

<

0.001)

TNM stage (OR=3.806

95% CI: 3.113-4.653

P

<

0.001) were risk factors for lymph node metastasis in group 12a of patients with gastric antrum cancer.

Conclusion:

The total lymph node metastasis rate in group 12a is low. Tumor size

invasion depth

N stage and tumor stage are independent risk factors for group 12a lymph node metastasis in gastric cancer. Besides

vascular nerve invasion is the independent risk factors for gastric body cancer. Gastric body cancer and gastric antrum cancer require routine dissection of group 12a lymph nodes. The metastatic rate of lymph nodes in group 12a of upper gastric cancer is low

and routine dissection is not required. However

when the diameter is ≥6 cm

the depth of tumor invasion is deep (T

3

-T

4

)

and the tumor stage is late (Ⅲ-Ⅳ)

group 12a lymph nodes need to be dissected.

关键词

Keywords

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