| Objective:Clinically,pN staging is often used to evaluate the lymph nodes status of patients with gastric cancer.However,pN staging is prone to be affected by the number of detected lymph nodes and leading to staging deviation.In addition,the number of lymph nodes detected for gastric cancer with different pT staging was diverse from each other.This study mainly discusses the influence of the number of lymph nodes detected on the prognosis of patients with gastric cancer,as well as the influence of lymph node detection on the prognosis of patients with gastric cancer at different pT staging.Methods:A retrospective analysis was made of the clinical and pathological data of 667 patients with gastric cancer who underwent radical surgery from January 2009 to December 2016 in the General Surgery Department of the Affiliated Hospital of Yan’an University.The survival period was followed up one by one.Then,all the collected data were analyzed by Kaplan-Meier method and draw survival curves item by item to screen out the risk factors affecting the 1-year,3-year and 5-year survival rate of patients with gastric cancer and to compare the survival rate differences among each risk factor group.Some of the quantitative risk factors of gastric cancer were searched by ROC curve for the dividing point that affected the survival rate of patients with gastric cancer.Then multivariate analysis was performed for the factors with statistical significance in the univariate analysis by established Cox proportional hazards model to comfirm the independent prognostic factors for gastric cancer.Finally,stratified analysis was carried out,The study data were stratified according to pT staging,and then Kaplan-Meier method was used to analyze the influence of the number of lymph nodes detected on the prognosis of patients with gastric cancer in different pT staging.Result:1.A total of 667 cases were included in this study.The 1-year cumulative survival rate was 81.4%.The 3-year survival rate was 63.6%.The 5-year cumulative survival rate was 55.7%,and the average survival time was 68.728±1.863 months.Median survival time was 84.000 months;2.The ROC curve showed that the cut-off point of the age of onset was 57 years.The cut-off point of operation time was 130 minutes.The cut-off point of blood loss was200 ml.The cut-off point of the tumor maximum diameter was 4 cm.The distance between the upper and lower cutting edges and the tumor was 2 cm and 4 cm.The cut-off point of lymph node metastasis rate was 9.50%.The number of nodes detected was 12,22,25;3.Univariate analysis showed that there were no statistical differences including the distance between the upper and lower incision margins and the tumor,and hemoglobin content,white blood cell count,CA72-4 content in a blood examination,histological type,Borrmann classification and HP status(P>0.05),and that there were significant statistical differences including the patients’ age of onset,gender,intraoperative blood loss,operating time,tumor site,tumor maximum diameter,number of detected lymph nodes,and platelet count,CEA content,CA19-9 content in a blood examination,rate of lymph node metastasis and the number of chemotherapy(P < 0.05);4.Multivariate analysis by Cox proportional hazards model showed that the the number of lymph node detected(RR=1.152,95.0% CI : 1.010-1.314),lymph node matastasis ratio(RR=3.460,95.0% CI : 2.568-4.663),Maximum tumor diameter(RR=1.485,95.0% CI:1.132-1.947),number of chemotherapy(RR=0.652,95.0% CI:0.527-0.806),CEA content(RR=1.676,95.0% CI : 1.289-2.180),CA19-9 content(RR=1.462,95.0% CI:1.114-1.918)were independent risk factors affecting the prognosis of gastric cancer patients(P<0.05);5.Survival analysis after stratification according to pT staging showed that there was no significant difference in survival rates among subgroups in pT1 and pT2 staging(P >0.05),and that there was significant difference in survival rates among subgroups in pT4 a and pT4 b staging(P < 0.05).The highest survival rates were achieved in each subgroup in the second subgroup,and the lowest survival rates were in the third subgroup.The survival rate of the first and second subgroup was significantly higher than that of the third and fourth subgroup.Conclusion:1.Independent risk factors for prognosis of gastric cancer patients include the number of lymph node detected,lymph node matastasis ratio,Maximum tumor diameter,number of chemotherapy,CEA content,CA19-9 content;2.The number of lymph nodes detected has different influence on the prognosis of patients with different pT staging.The survival rate caused by the increase of the number of lymph nodes detected in pT1 and pT2 staging has no statistical significance.The number of lymph nodes detected in pT4 a and pT4 b staging should be at least 22 to achieve a good prognosis,what’s more,it is possible that only 22 lymph nodes detected are still insufficient.3.The number of lymph nodes detected is one of the important independent risk factors affecting the prognosis of gastric cancer patients,which can supplement the TNM staging of gastric cancer and provide theoretical basis for the individualized surgical plan of gastric cancer patients. |
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