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中华普外科手术学杂志(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 337 -342. doi: 10.3877/cma.j.issn.1674-3946.2026.04.010

论著

早期胃癌淋巴结转移的危险因素及预后分析
张彬1,2, 王敏1, 郑鹏1, 冯犁1, 李鑫1, 赵高平2,()   
  1. 1 610075 成都,成都中医药大学附属医院普外科
    2 610072 成都,四川省医学科学院 四川省人民医院胃肠外科
  • 收稿日期:2025-11-25 出版日期:2026-08-26
  • 通信作者: 赵高平

Risk factors for lymph node metastasis and prognostic analysis of early gastric cancer

Bin Zhang1,2, Min Wang1, Peng Zheng1, Li Feng1, Xin Li1, Gaoping Zhao2,()   

  1. 1 Department of General Surgery, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan Province 610075, China
    2 Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu Sichuan Province 610072, China
  • Received:2025-11-25 Published:2026-08-26
  • Corresponding author: Gaoping Zhao
  • Supported by:
    Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, 2023 Hospital Fund(23TS06)
引用本文:

张彬, 王敏, 郑鹏, 冯犁, 李鑫, 赵高平. 早期胃癌淋巴结转移的危险因素及预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 337-342.

Bin Zhang, Min Wang, Peng Zheng, Li Feng, Xin Li, Gaoping Zhao. Risk factors for lymph node metastasis and prognostic analysis of early gastric cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(04): 337-342.

目的

探讨早期胃癌淋巴结转移的危险因素及预后。

方法

回顾性分析2015年1月至2020年1月行胃癌根治术的243例早期胃癌患者的临床资料,分析淋巴结转移的危险因素,对患者进行3年总生存率随访,绘制Kaplan-Meier生存曲线,评估淋巴结转移对患者预后的影响。对结局为定性资料应用二元Logistic回归进行分析;生存曲线利用Kaplan-Meier曲线绘制;诺莫图及受试者工作特征(ROC)曲线用R语言进行绘制。

结果

243例早期胃癌患者,淋巴结转移率为20.2%(49/243),T1a期7.3%(8/109),T1b期30.6%(41/134)。单因素分析显示,肿瘤分化较差、黏膜下侵犯、直径>2 cm及伴有溃疡与淋巴结转移相关;多因素分析结果显示肿瘤分化较差、黏膜下侵犯及肿瘤直径>2 cm是淋巴结转移的独立危险因素。3年总生存率96.2%;有无淋巴结转移(LNM)的3年总生存期(OS)比较,差异具有统计学意义(P<0.05)。根据独立危险因素绘制诺莫图,可以大致评估其淋巴结转移风险。

结论

早期胃癌淋巴结转移的独立危险因素是肿瘤分化程度较差、黏膜下侵犯及直径>2 cm;诺莫图可以大致评估淋巴结转移的风险;淋巴结转移会显著降低早期胃癌患者的预后。

Objective

To explore the risk factors for lymph node metastasis and the prognosis of patients with early gastric cancer.

Methods

The clinical data of 243 patients with early gastric cancer who underwent radical gastrectomy from January 2015 to January 2020 were retrospectively analyzed. Risk factors for lymph node metastasis were identified. All patients were followed up for 3-year overall survival, and Kaplan-Meier survival curves were plotted to evaluate the impact of lymph node metastasis on prognosis. Binary Logistic regression was used to analyze qualitative outcome data. Survival curves were generated with the Kaplan-Meier method. Nomograms and receiver operating characteristic (ROC) curves were established using R software.

Results

Among the 243 patients with early gastric cancer, the overall lymph node metastasis rate was 20.2% (49/243). The metastasis rate was 7.3% (8/109) in T1a stage and 30.6% (41/134) in T1b stage. Univariate analysis showed that poor tumor differentiation, submucosal invasion, tumor diameter > 2 cm and tumor ulceration were correlated with lymph node metastasis. Multivariate analysis revealed that poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm were independent risk factors for lymph node metastasis. The 3-year overall survival rate was 96.2%. There was a statistically significant difference in 3-year overall survival (OS) between patients with and without lymph node metastasis (LNM) (P<0.05). A nomogram was constructed based on the independent risk factors to preliminarily predict the risk of lymph node metastasis.

Conclusion

Poor tumor differentiation, submucosal invasion and tumor diameter > 2 cm are independent risk factors for lymph node metastasis in early gastric cancer. The nomogram can be used to roughly assess the risk of lymph node metastasis. Lymph node metastasis significantly worsens the prognosis of patients with early gastric cancer.

图1 2015年至2020年早期胃癌患者外科根治手术病例筛选图
表1 早期胃癌患者淋巴结转移的单因素分析[例(%)]
表2 早期胃癌患者淋巴结转移的多因素分析
图2 早期胃癌有无淋巴结转移患者的3年总生存期对比
图3 早期胃癌有无淋巴结转移患者的3年累积风险曲线对比
图4 早期胃癌淋巴结转移诺莫图
图5 诺莫图预测早期胃癌淋巴结转移的受试者操作特征曲线 注:AUC为曲线下面积
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