Author/Editor		Repše, Aljaž
Title		Napovedni dejavniki za prizadetost področnih bezgavk pri bolnikih z zgodnjim rakom želodca
Translated title		Predictive factors for regional lymph node involvement in early gastric cancer patients
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. 10
Publication year		2002
Volume		str. 629-33
Language		slo
Abstract		Background. Number of endoscopically treated early gastric cancer (EGC) patients has been constantly growing. EMR is relatively simple, unexpensive, has low complication rate and offers substantially better quality of life than classical operative therapy. Patients and methods.158 EGC patients were treated in Clinical centre Ljubljana from Jan. 1st 1983 to Dec. 31st 1997; 156 patients were operated on, 2 were treated endoscopically. Importance of several clinico-pathological predictive factors for lymph node involvement was first tested by chi-square test and then included in multivariate model. Results. 24 out of 156 (15.4%) resected patients had positive regional lymph nodes. Multivariate analysis proved the importance of depth of infiltration (p = 0.0005), of histological type by Lauren (p = 0.0087) and partly of the size of the lesion (p = 0.1355) as prognostic factors for regional lymph node involvement. Relative risk in submucosal EGC is 7.4 times greater than that in mucosal EGC. Diffuse type has 4.5 times and mixed 5.2 times the risk in intestinal type. Each cm in diameter increased the relative risk 1.2 times. Observed 5 year survival of our patients was 81.7% (85.7% in NO and 53.3% in N+ patients). Conclusions. EMR is the treatment of choice in patients with early gastric cancer and no regional lymph node metastases. Proper selection of patients by clinico-pathological predictive factors for regional lymph node metastases is essential. Beside two endoscopically treated atients, 12 patients were suitable for such a therapeutic procedure in our 15 year series.
Summary		Izhodišča. Endoskopsko zdravljenje bolnikov z zgodnjim rakom želodca (EGC) se vse bolj uveljavlja. Endoskopska mukozektomija (EMR) je razmeroma enostavna in poceni, ima malo zapletov in bolniku omogoča bistveno boljšo kakovost življenja kot klasično operativno zdravljenje. Bolniki in metode. V času od 1. 1. 1983 do 31. 12. 1997 se je v Kliničnem centru zdravilo158 bolnikov z EGC; 156 bolnikov je bilo operiranih, dva pa sta bila zdravljena endoskopsko. Pomen posameznih klinično patoloških napovednih dejavnikov za prizadetost področnih bezgavk smo najprej ocenili univariatno s testom hi-kvadrat, nato pa smo jih ocenili še v multivariatnem modelu. Rezultati. Med 156 operiranimi bolniki jih je imelo 24 (15,4%) prizadete področne bezgavke. Z multivariatno analizo smo dokazali pomen globine infiltracije tumorja v želodčno steno (p = 0,0005), histološkega tipa po Laurenu (p = 0,0087) in deloma velikosti sprememb (p = 0,1355) na prizadetost področnih bezgavk. Tveganje pri submukoznem tipu je 7,4-krat večje kotpri mukoznem tipu. Difuzni tip poveča tveganje za 4,5-krat, mešani pa 5,2-kratglede na intestinalni tip. Možnost za limfogene metastaze se je z vsakim cm velikosti povečala za 1,2-krat. Opazovano 5-letno preživetje bolnikov je bilo 81, 6% (85,7% pri NO in 53,3% pri N+), Zaključki. EMR je pri izbranih bolnikih z zgodnjim rakom želodca brez prizadetih področnih bezgavk najboljša metoda. Bistvena je pravilna izbira bolnikov na osnovi klinično patoloških napovednih dejavnikov. V naši 15-letni seriji je bilo poleg dveh endoskopsko zdravljenih bolnikov še 12 za tako zdravjenje primernih bolnikov.
Descriptors		STOMACH NEOPLASMS LYMPHATIC METASTASIS SURGERY, ENDOSCOPIC TREATMENT OUTCOME LOGISTIC MODELS SURVIVAL ANALYSIS