Hanazaki K, Sodeyama H, Mochizuki Y, Machida T, Yokoyama S, Sode Y, Wakabayashi M, Kawamura N, Miyazaki T, Amano J
Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2677-82.
BACKGROUND/AIMS: We retrospectively analyzed clinicopathologic data on 83 patients with advanced gastric cancer who underwent noncurative gastrectomy, with respect to the relation between the extent of lymphadenectomy and survival benefit.
These 83 patients were divided into 44 patients with limited or simple lymph node dissection (D0 in 14 and D1 in 30: Group A) and 39 patients with extended lymph node dissection (D2: Group B).
The 1-year survival rate in Group B (82.1%) was significantly higher than in Group A (49.0%). However, the 3-year and 5-year survival rates did not significantly differ between Group A versus Group B, 39.7% versus 25.7% and 39.7% versus 20.5%, respectively. Median survival time after surgery with and without distant metastasis in Group B (21.5 months) was longer than in Group A (16.4 months), although not significant.
While gastrectomy with extended lymphadenectomy did not contribute to improve long-term survival in patients with noncurable advanced gastric cancer, the utility of extended lymph node dissections may be relevant to improved locoregional control, at least in the prognosis within 1 year after surgery. Not only extended lymphadenectomy but also aggressive chemotherapy may be needed to improve the long-term survival for such patients.
背景/目的：我们回顾性分析了83例行非根治性胃切除术的晚期胃癌患者的临床病理资料，以探讨淋巴结清扫范围与生存获益之间的关系。
这83例患者分为44例行有限或简单淋巴结清扫的患者（14例为D0，30例为D1：A组）和39例行扩大淋巴结清扫的患者（D2：B组）。
B组的1年生存率（82.1%）显著高于A组（49.0%）。然而，A组与B组的3年和5年生存率无显著差异，分别为39.7%对25.7%和39.7%对20.5%。B组有远处转移和无远处转移患者术后的中位生存时间（21.5个月）长于A组（16.4个月），但差异不显著。
虽然扩大淋巴结清扫的胃切除术对不可治愈的晚期胃癌患者的长期生存改善无贡献，但扩大淋巴结清扫的作用可能与改善局部区域控制有关，至少在术后1年内的预后方面如此。对于此类患者，可能不仅需要扩大淋巴结清扫，还需要积极的化疗来改善长期生存。
