| Objective: To analyze the clinical and epidemiological characteristics of advanced gastric cancer in the Hengyang area,to identify the risk factors for lymph node metastasis in advanced gastric cancer in the Hengyang area,and to provide a statistical basis for clinical diagnosis and treatment of patients with advanced gastric cancer in the region.Methods: A retrospective analysis was performed on a total of 315 advanced gastric cancer cases from January 1,2017,to May 31,2019.The statistical software IBM SPSS,version 21.0,was used to perform frequency analysis on the clinical data and investigate the correlation between various clinical characteristics by the Chi-square test of independence.99 cases who underwent surgery to treat their advanced gastric cancer were further analyzed using the Chi-square test to investigate the association between various independent risk factors and lymphatic metastasis from gastric cancer,and a multiple logistic regression model was constructed to estimate the odds ratios for severalof these factors.Results:1.The ratio of male to female patients with advanced gastric cancer cases was 2.18:1.The highest proportion of patients belonged to the middle-old age group of 60-69 years(34.6%)than other age groups.80.6% of patients lived in suburban and rural counties,and most were farmers.The most common initial symptom was abdominal distension or pain(75.9%).The most common complications were anemia(37.1%)and bleeding(32.7%).The gastric antrum(54.4%)and the stomach body(30.5%)were the most common sites for gastric cancer.Tumors with a maximum diameter of <5 cm(42.2%),Borrmann type III gastric cancer(46.3%),gastric adenocarcinoma(71.4%),poorly differentiated carcinoma(40.6%),diffuse-type cancer(15.9%),and stage Ⅳ cancer(16.8%)were common.After pathological examination,19% of the cases were found to have tumor thrombus,and 43.2% of cases had tumor metastasis.2.Categorical comparison of advanced gastric cancer clinical characteristics2.1 There were statistically significant differences in the age of onset(P=0.020)and occupation(P=0.000)between urban and suburban/rural patients in Hengyang area.The correlation between gender and the tumor location(P=0.007),the tumor size(P=0.043)and the tumor pathologicalclassification(P=0.007)were also statistically significant.However,the differences in tumor location(P=0.281),tumor size(P=0.184),tumor WHO classification(P=0.940),cTNM stage classification(P=0.281)and tumor metastasis(P=0.515)between different age groups weren’t statistically significant.2.2 There were statistically significant differences in the tumor size(P=0.018)and location(P=0.000)between the presence and absence of gastric obstruction.Furthermore,the tumor site was statistically correlated with the presence of abdominal distension and pain as symptoms(P=0.024).The tumor WHO classification was not found to be statistically correlated with the tumor Borrmann classification(P=0.249),but it was statistically correlated with the tumor location(P=0.009).2.4The occurrence of tumor metastasis was statistically correlated with the tumor WHO classification(P=0.007),but the difference in occurrence of metastasis between tumor locations(P=0.469>0.05)wasn’t statistically significant.3.Analysis of risk factors and odds ratios for lymphatic metastasis in advanced gastric cancer3.1 A total of 2,058 lymph nodes from biopsy were sent for pathological examination;and an average of 20.79±9.50 nodes per case were examined.427 lymph nodes were found to be metastatic,and the lymph node ratio(LNR)was 20.7;the lymph node metastasis rate in thisgroup of cases was 65.7%.3.2 The presence of lymphatic metastasis in advanced gastric cancer was found to be statistically correlated to the tumor size(P=0.000),the age of onset(P=0.041),the tumor Borrmann classification(P=0.007),the cTNM stage classification(P=0.000),the occurrence of tumor thrombus(P=0.000)and other factors.3.3 The odds ratios(OR)for lymphatic metastasis were estimated to be 10.406(95% CI(2.867-37.771),P=0.000)for the tumor size in cm,1.064(95% CI(1.003-1.129),P=0.041)for the age of onset and 11.660(95% CI(2.848-47.745),P=0.001)for tumor thrombus vs.no thrombus.Conclusions:1.Male farmers over 60 years of age who live in suburban and rural areas were the most prone to developing advanced gastric cancer in the Hengyang area.The main initial symptoms were abdominal distension and abdominal pain.Borrmann type III cancer was common,and cancer in the lower and middle stomach were common.Adenocarcinoma,diffuse-type carcinoma(Lauren classification)and ulcerating tumors(macroscopic classification)were also common.The most common locations for gastric tumors were different between patients in the Hengyang area and patients from areas north of the Yangtze River.2.The clinical characteristics of patients with advanced gastric cancer in the Hengyang region were found to be different between thosewho live in an urban environment and those who live in suburban/rural areas.The tumor location,tumor size and pathological characteristics differed by gender,but these characteristics were not statistically correlated with the age of onset.3.Even with limited data,the rate of lymphatic metastasis was found to be high.Age,tumor size and tumor thrombus were significant risk factors for lymph node metastasis in the Hengyang area and can be used as predictive indicators. |
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