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目的创立一个术前预测胃癌淋巴转移(N)分期的综合评分系统。方法回顾性分析291例胃癌患者的临床病理资料,单因素和多因素分析筛选出影响实际淋巴转移病理分期(pN)水平高低的临床参数,赋予各参数不同的计分分值。绘制接受者工作特征曲线,确定预测各N分期的评分标准。Kappa检验和诊断试验法评估该评分系统对实际pN分期的预测价值。结果肿瘤大小、肿瘤浸润深度及组织学类型被筛选为计分依据。综合得分0~4分预示N0期,5~7分预示N1,8~9分预示N2,10~13分预示N3。评分系统预测N分期与实际pN分期之间具有高度一致性(加权Kappa=0.605,u=14.548,P<0.01)。评分系统对实际pN分期的总体阳性预测值为65.6%,阴性预测值为88.5%,粗一致率为82.8%。结论建立的术前预测胃癌N分期综合评分系统简单易行,结果比较可靠,能够为手术者选择合理的淋巴结切除范围提供帮助。
Objective To establish a comprehensive preoperative prediction of gastric cancer lymph node metastasis (N) staging system. Methods A retrospective analysis of clinical and pathological data of 291 cases of gastric cancer patients, single factor and multivariate analysis of clinical parameters affecting the actual lymphatic metastasis pathological stage (pN) level, giving different score points for each parameter. Draw the receiver’s operating characteristic curve to determine the score for each N staging. Kappa test and diagnostic test to assess the predictive value of the scoring system for the actual pN staging. Results The tumor size, tumor invasion depth and histological type were scored as scoring basis. Comprehensive score of 0 to 4 points indicates the N0 period, 5 to 7 points indicate N1, 8 to 9 points indicate N2, 10 to 13 points indicate N3. The scoring system predicted a high degree of agreement between N staging and actual pN staging (weighted Kappa = 0.605, u = 14.548, P <0.01). The overall positive predictive value of the scoring system for actual pN staging was 65.6%, the negative predictive value was 88.5%, and the crude concordance rate was 82.8%. Conclusion The preoperative prediction of gastric cancer with N staging comprehensive score system is simple and easy, the results more reliable, able to select reasonable surgical resection of lymph nodes to help.