| Background:gastric cancer is one of the most common cancers in clinical practice.It is a malignant tumor mainly caused by gastric mucosal epithelium and glandular epithelium.The onset age of gastric cancer is usually between 40 and 60 years old.The incidence rate of male cancer is more than that of female.So far,the pathogenesis of gastric cancer has not been fully elucidated,and it is believed that it is related to diet and environment and has geographical distribution characteristics.Statistics show that the incidence of gastric cancer in Japan,Chile,Colombia,Hungary and some western regions of China is much higher than in the United States or Western Europe.Some studies have shown that gastric cancer is still one of the common malignant tumors in China,and it has regional characteristics.In terms of its incidence,the incidence of gastric cancer in the north is significantly higher than that in the south,and the incidence of gastric cancer in the countryside is significantly higher than that in cities.Men have higher morbidity and mortality rates than women.Statistics also show that the average annual mortality rate in China is about 16/100,000.At present,the main methods to treat gastric cancer are surgery,radiotherapy and chemotherapy.Radical surgery is one of the most common methods.In recent years,studies have shown that the extent to which lymph node tissues have been removed largely determines the survival time and quality of life of patients.However,if the lymph nodes without cancer metastasis are removed and dissected in a large scale during the treatment of patients with gastric cancer surgery,the surgery will not only increase the trauma to patients,but also affect the patients' immune function and greatly reduce the therapeutic effect.Therefore,it is particularly important to study the biological behavior of lymph node metastasis in gastric cancer.To master the rule of lymph node metastasis of gastric cancer can not only completely remove the lesion of gastric cancer,but also thoroughly clear the metastatic range of lymph nodes.Therefore,the evaluation of lymph node metastasis based on the biological behavior of gastric cancer can be used as the basis for the adjustment of treatment plan,which has important clinical significance for the prognosis of patients.Objective:to study the rule of lymph node metastasis in gastric cancer and summarize the factors influencing lymph node metastasis in gastric cancer.Methods:in this study,1440 patients with gastric cancer who received elective radical gastrectomy for gastric cancer in our hospital from December 2014 to December 2018 were selected as the study subjects,including 1040 males and 400 females.The average age is 31-80 years old(62.2 ± 4.8 years).The finish most of distal gastric resection type anastomosis in 560 cases patients,most of the distal gastric resection? anastomosis with 68 Ocases of patients,60 patients with most recent stomach resection,140 patients with total gastrectomy.All patients included in the study were immediately examined for lymph nodes and separated after surgical removal of the specimen,and then grouped according to lymph node metastases.The samples were fixed with formalin and sent to the pathology department for examination in time.The location,size,lymph node metastasis and pathological types of tumor in 1440 patients with gastric cancer were statistically analyzed.According to the Japanese Research Society for Gastric Cancer,Gastric lymph nodes are divided into 18 groups of 3 stations.Based on the location of tumor,lymph nodes in each group were divided into N1-N3 stations.Subsequently,the tumor infiltration depth,tumor location,tumor general morphology,tumor size,gender,histological type and age of the patients were calculated,so as to explore the relationship between the above indicators and lymph node metastasis of gastric cancer.At the same time,all patients with gastric cancer lymph node metastasis group were counted to explore the lymph node metastasis rule.Results:1.The invasion depth of gastric wall tissue was classified according to the tumor.The patients in groups T1,T2,T3 and T4 were 180,300,760 and 200,respectively.The results showed that only 20 patients in the T1 group had lymph node metastasis to N1 station,and the metastasis rate was 11.1%(20/180).In the T2 group,120 patients with lymph node metastasis to N1 station had a metastatic rate of 40%(120/300),while those without lymph node metastasis to N2 and N3 stations had no metastasis.In the T3 group,there were 320 patients with lymph node metastasis to N1 station,with a metastatic rate of 42.2%(320/760),240 patients transferred to N2 station,with a metastatic rate of 31.5%(240/760),40 patients transferred to N3 station,with a metastatic rate of 5.4%(40/760),and 20 patients transferred to M1 station,with a metastatic rate of 2.6%(20/760).In the T4 group,there were 80 patients with lymph node metastasis to N1 station,with a metastatic rate of 40%(80/200)and 60 patients transferred to N2 station with a metastatic rate of 30%(60/200).In the patients without lymph node metastasis to N3 station,the metastatic rate was 0,and 40 patients transferred to M1 station with a metastatic rate of 20%(40/200).In addition,jumping metastasis was observed in some T3 stage gastric cancer.Lymph node metastasis in the T4 group was>,T3,>,T2,>,T1.2.Lymph node metastasis rate of upper gastric cancer was 66.7%(40/60),central lymph node metastasis rate was 58.2%(280/480),and lower lymph node metastasis rate was 69.1%(620/900).According to statistical analysis,lymph node metastasis rate was unrelated to upper,middle or lower gastric cancer(P<0.05).3.According to the different infiltration degree,180 patients with early gastric cancer and 1260 patients with advanced gastric cancer were classified.The results showed that the lymph node metastasis rate of early gastric cancer patients was 11.1%,while the lymph node metastasis rate of advanced gastric cancer was 72.9%,and the lymph node metastasis rate of advanced gastric cancer was significantly higher than that of early gastric cancer(P<0.05).Bormann classification was used to classify advanced gastric cancer.Polyps,limited ulcers,infiltrated ulcers and diffuse infiltration types were 80,360,780 and 40,respectively.The lymph node metastases were 50.0%,55.6%,79.5%and 100%,respectively.The lymph node metastasis rate was 54.56%,the infiltrated ulcer type and diffuse infiltration type were classified as infiltration type,and the lymph node metastasis rate was 80.4%.The lymph node metastasis rate of infiltrated gastric cancer was much higher than that of confined gastric cancer(P<0.05).4.Based on previous studies,this study divided patients into 3 groups with tumor diameters of 3cm and 5cm,with diameters of<3cm,3-5cm and>5cm respectively.The number of patients in each group was 520,520 and 400,respectively.According to statistical analysis,the incidence of lymph node metastasis in patients with gastric cancer with tumor diameter of>5cm was higher than those with diameter of 3-5cm and<3cm(P<0.05).5.In this study,1040 male patients and 400 female patients had gastric cancer lymph node metastasis rates of 67.4%and 60.0%,respectively,with no significant difference(P>0.05).6.The histological types of the included subjects were low differentiated adenocarcinoma,signet ring cell carcinoma,middle differentiated adenocarcinoma,high differentiated adenocarcinoma and mucinous adenocarcinoma respectively from high to high,and the other 20 patients were squamous cell carcinoma.The lymph node metastasis rate of all histological types of gastric cancer was calculated,among which,the lymph node metastasis rate of mucinous adenocarcinoma reached 100%,that of hypodifferentiated adenocarcinoma was 67.5%,that of signet ring cell carcinoma was 61.5%,that of moderately differentiated squamous cell carcinoma was 40.0%,and that of highly differentiated squamous cell carcinoma was 0%.The highly differentiated and moderately differentiated adenocarcinoma was divided into the well-differentiated group,while the low-differentiated,mucinous adenocarcinoma and signet ring cell carcinoma were divided into the poorly differentiated group.The results showed that the lymph node metastasis rate of the well-differentiated group was significantly lower than that of the well-differentiated group(P<0.05).7.All patients were divided into the age group<50 years old,the 50-70 year old group and the>70 year old group at the cut-off point of 50 years old and 70 years old.According to the statistics of lymph node metastasis rate of each group,the results showed that:the metastasis rate of patients in the 50-year-old group was 71.5%,that of patients in the 50-70-year-old group was 64.2%,that of patients in the>70-year-old group was 63.1%,and there was no significant difference between the three groups(P>0.05).8.Of the 1440 patients in this study,a total of 1,7460 lymph nodes were dissected,among which 3490 tumor metastases and 20.1%tumor metastasis rate were detected.According to the statistics of lymph node metastasis in each group,the results showed that the major lymph node metastasis was mainly concentrated in NO3,NO6 and NO4,followed by NO1 and NO7.9.Lymph node metastasis of gastric cancer in different locations was mainly concentrated in N1 and N2 stations.The lymph node metastasis of gastric cancer in cardiac position is mainly in NO3,NO2 and NO1,among which NO3 has the most metastasis.If the tumor of the patient is in question,lymph node metastasis is mainly concentrated in N04,N03 and N06,among which the highest rate of N1 metastasis is N04 and the highest rate of N2 metastasis is N07.The tumors in the gastric sinus were mainly NO6,NO1,NO3,NO4,NO5,NO6,NO7 and NO8,among which N07 metastasized to the N2 station was the largest.Conclusion:lymph node metastasis of gastric cancer is mainly affected by tumor size,infiltration depth,histological classification and general morphology.Lymph node metastasis in gastric cancer is not affected by the patient's age,gender or tumor location.In the process of lymph node metastasis of gastric cancer,N1 station is the main site.As the degree of metastasis increases,it will be transferred to N2,N3 and M stations successively,and there will be gradual decline.According to the biological characteristics of gastric cancer,the treatment plan of patients can be improved,and the prognosis of patients can be evaluated. |
PDF Full Text Request