Affecting Factors Of Recurrence Or Metastasis Of Gastric Cancer After D2 Lymph Node Dissection

Objective:(1)To explore the influencing factors of recurrence and metastasis of gastric cancer patients after laparotomy or laparoscopic D2 lymph node dissection,so as to provide theoretical basis for postoperative monitoring of gastric cancer;(2)To investigate the effects of peripheral blood T cells and cytokines on recurrence and metastasis of gastric cancer after D2 lymph node dissection.Methods:A total of one hundred and thirty-six patients with gastric cancer were collected between May 1,2018 and September 3,2019,who underwent laparotomy or laparoscopic D2 lymph node dissection in the Department of Abdominal Surgery of the Third Affiliated Hospital of Kunming Medical University after sampling under gastroscopy and were confirmed as gastric cancer by pathological examination and imaging examination.To retrospectively analyze the total number of recurrent cases,common metastatic tissues and organs,and overall survival of gastric cancer patients after D2 lymph node dissection,simultaneous analysis of T cell subsets and cytokines(CD4+/CD8+ratio,NK cell ratio,CD4+T cell ratio,CD8+T cell ratio,CIK cell ratio,interleukin-2,interleukin-4,interleukin-6,Interleukin-10,interferon gamma,tumor necrosis factor alpha)on the recurrence and metastasis of gastric cancer patients after D2 radical resection,and whether it is related to the length of survival.Kaplan-Meier survival analysis was used for univariate analysis,and the Cox risk proportional regression model was used for multivariate analysis for statistically significant single factors.Results:(1)A total of one hundred and thirty-six patients with gastric cancer after underwent laparotomy or laparoscopic D2 lymph node dissection were collected.Thirty-six patients showed recurrence or metastasis of varying degrees after D2 lymph node dissection,with a total recurrence or metastasis rate of 26.5%,and thirty patients was died,with a mortality rate of 22.1%.The 18-month disease-free survival(DFS)and 18-month overall survival(OS)were 77.2%and 86.7%,respectively.Abdominal lymph node metastasis was the most common site of distant metastasis in gastric cancer patients after D2 lymph node dissection,accounting for 8.8%(12/136).Peritoneal metastasis was 7.4%(10/136),liver metastasis 5.8%(8/136),lung metastasis 2.2%(3/136).(2)Univariate analysis was performed on seven different dimensions,including immune function status indicators,tumor markers,mismatch repair genes,Ki-67,EBV infection,HP infection and clinicopathological characteristics,by Log-rank test.AFP,CA15-3,CA72-4,CEA values,TNM stage,nerve vessel invasion,tumor diameter and lymph node metastasis in serum were detected.The ratio of CD3+T cells and the expression of interleukin-4 in serum were correlated with the DFS and OS of gastric cancer patients after D2 radical operation(p<0.05).The above factors with p<0.05 for univariate analysis were further included in the multivariate Cox proportional risk regression model for analysis,and the analysis showed that:TNM stage Ⅲ～Ⅳ,CEA>3.4μg/L,tumor thrombus invasion of nerve or vessel,CD3+T cell ratio≤76.3%,interleukin 4>30.85Pg/ml were independent risk factors for DFS after radical D2 lymph node dissection in gastric cancer patients(p<0.05).The CEA>3.4μg/L,tumor thrombus invasion of nerve or vessel,CD3+T cell ratio≤76.3%,interleukin 4>30.85Pg/ml were independent risk factors for OS after radical D2 lymph node dissection in gastric cancer patients(F<0.05).Conclusion(s):(1)Abdominal lymph node metastasis is the most common site of distant metastasis in gastric cancer patients after D2 lymph node dissection by laparotomy or laparoscopy,and the others appear in the order peritoneal metastasis,liver metastasis,and lung metastasis.(2)The value of tumor markers CEA,CA15-3,CA72-4,AFP in peripheral blood,TNM stage,presence of nerve vessel invasion,presence of lymph node metastasis,and tumor diameter;The ratio of CD3+T lymphocytes and the level of interleukin-4 in preoperative serum were correlated with the recurrence,metastasis and survival time of gastric cancer patients after D2 lymph node dissection by laparotomy or laparoscopy.(3)TNM stage Ⅲ-Ⅳ,nerve or vessel with tumor thromb invasion,CEA>3.4μg/L,CD3+T cell ratio≤76.3%,and interleuk-4>30.85Pg/ml were independent risk factors for recurrence and metastasis of gastric cancer patients after D2 radical gastrectomy by laparotomy or laparoscopy.