Schwarz Roderich E, Smith David D
Division of Surgical Oncology (RES), The Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA.
Ann Surg Oncol. 2007 Feb;14(2):317-28. doi: 10.1245/s10434-006-9218-2. Epub 2006 Nov 9.
Advanced, but potentially still curable gastric cancer (stages IIIA, IIIB, or stage IV M0) is associated with very high recurrence rates after gastrectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting.
A resected gastric cancer data set was created through structured queries to the SEER 1973-2000 database. Relationships between the number of lymph nodes (LNs) examined and survival outcomes were analyzed for the stage subgroups characterized by the N categories N2 or N3, and transmural tumor extension (T categories T2b or T3).
The study group encompassed 1,377 patients, including T2b/3N2 (n = 1,076) and T2b/3N3 stage subgroups (n = 301). Total LN count (or number of negative LNs examined; P < 0.0001), number of positive LNs (P < 0.0001), age (P < 0.0001), primary site (P = 0.0002), T category (P = 0.0271), race (P = 0.0301) and gender (P = 0.0261) were independent prognostic survival predictors. A cut point analysis yielded the ability to detect significant survival differences for LN numbers up to 30 (N2) or up to 40 (N3), always in favor of the higher number of LNs examined. Best long-term survival outcomes were observed with negative LN counts of more than 15 (N2) or more than 20 (N3).
Even in transmural or serosa-positive gastric cancer with advanced nodal involvement, more extensive LN dissection and analysis influences survival. Stage-based survival prediction depends on total LN number and number of negative LNs. The mechanism remains uncertain, but is not limited to stage migration. ELND during potentially curative gastrectomy is recommended even for advanced gastric cancer.
进展期但仍有可能治愈的胃癌（ⅢA期、ⅢB期或Ⅳ期M0）在胃切除术后复发率非常高。在这种情况下，扩大淋巴结清扫术（ELND）的价值仍不明确。
通过对SEER 1973 - 2000数据库进行结构化查询创建了一个切除的胃癌数据集。分析了以N分类为N2或N3以及肿瘤穿透壁层（T分类为T2b或T3）为特征的分期亚组中检查的淋巴结（LN）数量与生存结果之间的关系。
研究组包括1377例患者，其中T2b/3N2（n = 1076）和T2b/3N3分期亚组（n = 301）。总LN计数（或检查的阴性LN数量；P < 0.0001）、阳性LN数量（P < 0.0001）、年龄（P < 0.0001）、原发部位（P = 0.0002）、T分类（P = 0.0271）、种族（P = 0.0301）和性别（P = 0.0261）是独立的生存预后预测因素。切点分析显示，对于N2期最多30个或N3期最多40个LN数量，能够检测到显著的生存差异，总是有利于检查的LN数量更多。当阴性LN计数超过15个（N2）或超过20个（N3）时，观察到最佳的长期生存结果。
即使在有晚期淋巴结受累的穿透壁层或浆膜阳性胃癌中，更广泛的LN清扫和分析也会影响生存。基于分期的生存预测取决于总LN数量和阴性LN数量。其机制仍不确定，但不限于分期迁移。即使对于进展期胃癌，也建议在可能治愈性胃切除术中进行ELND。
