The Rule Of Lymphatic Metastasis And Analysis Of Prognosis Influencing Factor For Gastric Carcinoma

Objectives: To explore the rules of lymph node metastasis in gastric cancer. This study wished to investigate appropriative way to improve curative effect and survival rate of surgical therapy and improve quality of life for gastric cancer through analysis of prognostic factors of 386 cases underwent gastric resection.Methods: 386 patients with gastric carcinoma who were operated upon in the department of abdominal surgery in Dalian medical university clinical institution from January, 2001, were followed up until April, 2003. To analyza the relationship between lymph node metastasis rate and tumor diameters, TNM classification, Borrmann analysis, tumor localization and the extent of lymph node resection. The survival rates were analysed with Kaplan-meier and then analysed with univarite and multivariate analysis of cox regression.Results:(1) Rates of lymph node metastasis among BorrmannⅠ,Ⅱ,Ⅲ, andⅣwere 41.67%, 61.16%, 89.71% and 90.32%; respectively(χ~2=45.79, P <0.01); and that among T1, T2, and T3 were 8.51%, 44.32% and 88.05%(χ~2=146.41, P<0.01); The rates of lymph node metastasis among well-differentiated, moderately differentiated, and poorly differentiated adenocarcinoma were 28.13%, 40.98% and 76.97%, the rates of lymph node metastasis in mucinous adenocarcinoma and signet-ring cell carcinoma were 78.35% and 87.97%. Rates of lymph node metastasis were 23.21%, 69.39% and 81.42% (χ~2=67.31, P< 0.01) corresponding to the different tumor diameters of that < 3.0cm, 3.0～5.0cm and > 5.0cm. The total lymph node metastatic rate was 68.39% in this 386 patients. The metastasis was related to the tumor location, the most commonly seen in No3 for the cancer located in the upper third and middle third of the stomach and in No6 and No3 in the lower-third.(2) 0f 386 cases, The 1-year over-all survival rate was 81.67%, The 3-year over-all survival rate was 51.57%, The 5-year over-all survival rate was 42.23%.(3) Univariate analysis showed that the predictors of survival in gastric cancer patients were tumor location, Bomnann type, way of resection, radical resection, time of chemotherapy, pathological type, depth of tumor invasion, lymph node metastases, TNM staging.(4) Multivariate analysis showed that four major significant prognostic factors as Borrmann types, radical gastrectomy TNM staging and time of chemotherapy.(5) 38.9% of 386 patients with gastric cancer were approached D1 or D1+ resection, 61.1% of them were approached D2 or D2+ resection. The one-year survival rate of D1 resection was 77.92%, three-year survival rate was 45.81%, five-year survival rate was 40.75%. The one-year survival rate of D2 resection was 84.57%, three-year survival rate was 56.87%, five-year survival rate was 44.28%.Conclusion: Lymphatic metastasis for gastric carcinoma involved in biological characteristic. To improve the survival rate of gastric cancer, the reasonable plan of gastrectomy should be drawn up and the synthetic treatment around gastrectomy should be performed basing on biological characteristic of each patient such as TNM clinical stage, Borrmann type and so on.