| Objective: Stomach cancer is the most common malignancy in our country, annual number of deaths due to gastric cancer ranks first,Its mortality rate is second only to lung cancer accounts for the second, the new cases of patients gastric cancer each year worldwide nearly 900,000,about 41% occurred in China,Stomach cancer deaths worldwide every year approximately 500 000,China accounted for 35%.After 65 years the incidence of gastric cancer was significantly higher tendency,elderly patients up to 28.5%, And increased incidence with age will gradually increase.Currently,treatment of gastric cancer is surgery combined therapy,radical surgery can greatly influence the prognosis.Lymph node metastasis and metastasis has been recognized as an important independent prognostic factor in gastric cancer,therefore, the standard surgical procedure has become a key part of the lymph node dissection,also determines to a certain extent from the survival of patients after surgery.During surgery lymph node dissection has been the focus of research focus and debate.For the elderly,modern surgical treatment focuses on strengthening the safety requirements while improving radical improving the quality of life on the basis of ensuring the survival the reasonable range of lymph node dissection,so that the surgical treatment of gastric cancer in the elderly is more rationalization, standardization。The article according to the "standard of diagnosis and treatment of gastric cancer, gastric cancer clinical practice guidelines", "gastric cancer treatment guidelines" in a variety of biological behavior of the clinical characteristics of research and analysis, to explore the regularity of lymph node metastasis, provide evidence-based certainbasis forreasonable for surgical therapy.Methods: Collect 11507 qualified the aged gastric cancer patients of NO.4 Hospital affiliated Hebei Medical university from Jan.1963 to Dec2013,Which accepts ordinary surgical treatment 3183 cases.The inclusion criteria of this study:1.Older than 60 years old;2.Preoperative and postoperative pathologic examination-related information is complete;3.All cases had lymph node surgery pathology report. Lymph node were systemiced and classified them into different gender, tumor size, tumor location different, TNM stage and tumor differentiation, count statistics and analyse the rule of Lymph node metastasis. These data are statistically described and analysed by software SPSS19.0 and P<0.05 indicates stastistical significance.Results: Collect 3183 qualified the aged gastric cancer patients admitted in general surgery department of NO.4 Hospital affilliatted Hebei Medical University from Nov.1963 to Dec. 2013,male 2490 and female 693, the male to female ratio is 3.59 to 1.Among the 1193 cases of fundus of stomach(37.48%), 438 cases of body stomach(13.76%), 1303 cases of antrum of stomach(40.94%), 249 cases of total stomach(7.82%).There are 1190 tumor size less than 5cm,greater than 5cm 1993. The number of TNM stage Ⅰ, Ⅱis 1187,Ⅲ、Ⅳ is 1996.The number of tumor well-differentiated is 1190, poorly differentiated is1993. Another Borrmann type in 2682 cases, including 135 cases of Borrmann type, Borrmann type 995 cases, Borrmann in 1291 cases of Borrmann III, IV in 261 cases. 1 Lymph node metastasis in elderly patients with gastric cancer overall Among the 3183 cases, 2186 cases of lymph node metastasis, metastasis rate of 68.68%. 2 The elderly among different sex rate of lymph node metastasis In 2490 cases of senile male patients with gastric carcinoma, lymph node metastasis and 1677 cases of right, the transfer rate is 67.35%;Elderly women of 693 cases of gastric cancer, 489 cases with lymph node metastasis, rate was 70.56%. According to χ2 test, χ2= 2.575,P=0.109,P>0.05, that difference is not statistically significant.3 In different parts of gastric cancer lymph node metastasis rate and degree In 1193 cases of fundus stomach,including 783 cases with lymph bode metastasis,the metastasis rate is 65.63%.In 438 cases of body stomach, including 269 cases with lymph bode metastasis, the metastasis rate is 61.42%.In 1303 cases of antrum stomach, including 892 cases with lymph bode metastasis,the metastasis rate is 68.46%.In 249 cases of total stomach, including 222 cases with lymph bode metastasis,the metastasis rate is 89.16%.According to χ2 test, χ2=63.191,P=0.000, P<0.05, statistically significant In fundus of stomach collection 18364 lymph node, including 4553 lymph node with tumor metastasis, the metastasis rate is 24.80%.In body of stomach collection 6961 lymph node,including 1644 lymph node with tumor metastasis, the metastasis rate is 23.62%.In antrum of total stomach collection 20606 lymph node,including 5382 lymph node with tumor metastasis, the metastasis rate is 26.12%.In total stomach collection 3815 lymph node,including 1910 lymph node with tumor metastasis, the metastasis rate is 50.07%.According to χ2 test, χ2=1120.313,P=0.000,P<0.05, statistically significant. 4 Tumor size lymph node metastasis rate In 1164 cases the tumor is less than 5cm, 596 cases of lymph node metastasis, metastasis rate was 51.20%; In 2019 cases the tumor is greater than or equal to 5cm, 1570 cases of lymph node metastasis, metastasis rate was 77.76%. According to χ2 test, χ2=239.527,P=0.000,P<0.05,statistically significant. 5 TNM staging gastric cancer lymph node metastasis rate Stage I and II were 1187 cases, 271 cases of lymph node metastasis, metastasis rate was 22.83%; III-IV period a total of 1996 cases, 1895 cases of lymph node metastasis, metastasis rate was 94.94%. According to χ2 test, χ2=1780.123,P=0.000,P<0.05, statistically significant 6 Metastasis rate of Poorly differentiated and well-differentiatedThe well-differentiated of the 1190 cases were good, 772 cases of metastasis,metastasis rate was 64.87%; The poorly differentiated of the 1993 cases were good, 1394 cases of metastasis,metastasis rate was 69.94%. According to χ2 test, χ2=8.812,P=0.003,P<0.05, statistically significant. 7 Different type of Borrmann in the lymph node metastasis rate Among the 135 cases of Borrmann type, lymph node metastasis in 87 cases, metastatic rate was 64.44%; Borrmann 995 cases of type II, 622 cases of lymph node metastasis,metastasis rate was 62.51%; 1291 cases of Borrmann type, 976 cases of lymph node metastasis, metastasis rate was 75.60%; Borrmann type in 261 cases, 224 cases lymph node metastasis, metastasis rate was 85.82%. 8 Metastasis rate of different groups The highest metastasis rate is 3 rd group(57.23%), higher than group 7,group 6, group 1, group 4, group 2, group 8, group 5, group 9,group 11, group 12, group 10, group 16, group 14, group 13, group15. According to χ2 test, the χ2=6915.820,P=0.000,P<0.05,statistically significant.Conclusion: In this paper, we statistically analyze 3183 clinical cases and conclude as follows: 1 The incidence of gastric cancer in the elderly male to female ratio was 3.59:1, the male was higher than female. 2 Elderly patients with gastric cancer lymph node metastasis rate was 68.68%. 3 The old people full stomach cancer lymph node metastasis rate(89.16%) was significantly higher than that in the gastric cardia(65.63%), body of stomach(61.42%), gastric antrum(68.46%). The location of the tumor metastatic lymph nodes of different rate,lymph node dissection can learn the rules. 4 Elderly patients with gastric cancer tumor diameter less than 5cm of the lymph node metastasis rate was 51.20%; the tumor than transfer is equal tothe rate of 5cm was 77.76%, lymph node metastasis rate is higher in large diameter the difference was statistically significant. 5 TNM stage III, IV of the lymph node metastasis rate of 94.94% was significantly higher than that of I, II 22.83% the difference was statistically significant. 6 Poor differentiation degree lymph node metastasis rate was 69.94% compared with the degree of well-differentiation of the 64.87% high the difference was statistically significant. 7 BorrmannⅠtype of lymph node metastasis rate was 64.44%; BorrmannⅡ type was 62.51%; BorrmannⅢ was 75.60% and BorrmannⅣ type was 85.82% the difference was statistically significant. 8 Although the transfer rate is different, but the elderly gastric cancer lymph node metastasis are possible. Highest metastasis rate is the 3 rd group(57.23%), higher than group 7, group 6, group 1, group 4, and group 2, group 8, group 5, group 9,group 11, and group 12, group 10, group 16, group 14, group 13, group15. |
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