Saito Hiroaki, Tsujitani Shunichi, Ikeguchi Masahide
Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan.
Gastric Cancer. 2007;10(2):87-91. doi: 10.1007/s10120-007-0412-0. Epub 2007 Jun 25.
Metastasis appearing to bypass or skip tiers of lymph nodes (LNs) has been referred to as skip metastasis. The clinical impact of skip metastasis in gastric cancer remains unclear.
In patients with gastric cancer, the clinicopathological features and postoperative prognoses of 21 patients with skip metastasis were evaluated and compared with findings in patients with group 1 (N1) or group 2 (N2) LN metastasis.
Of the 21 patients with skip metastasis, 9 patients had metastasis in the LN along the common hepatic artery (No. 8a), 8 patients had metastasis in the LN along the left gastric artery (No. 7), 2 patients had metastasis in LNs No. 7 and No. 8a, 1 patient had metastasis in the LN at the splenic hilum (No. 10), and 1 patient had metastasis in LN No. 10 and the LN along the splenic artery (No. 11). The mean diameter of the tumors in the patients with skip metastasis was 5.7 +/- 2.4 cm, which was significantly smaller than those in the N1 patients (7.9 +/- 4.1 cm) and N2 patients (9.3 +/- 4.6 cm). The incidence of serosal invasion, lymphatic vessel invasion, and peritoneal metastasis was lower in patients with skip metastasis compared with N2 patients. The 5-year survival rates were 70.2%, 62.0%, and 31.2% in patients with skip metastasis, patients with metastasis in group 1 LNs, and those with metastasis in group 2 LNs, respectively. The prognosis of patients with metastasis in group 2 LNs was significantly worse than that of patients with either skip metastasis (P = 0.0029) or metastasis in group 1 LNs (P < 0.0001).
Our data indicate that both the clinicopathological characteristics and the prognoses of patients with skip metastasis were similar to those of patients with N1 LN metastasis, but these features were not similar to those in patients with N2 LN metastasis. The sites of skip metastasis presented in the current study may be the key for applying the concept of the sentinel node in gastric cancer.
转移灶似乎绕过或跳跃淋巴结层级，这种情况被称为跳跃转移。胃癌中跳跃转移的临床影响仍不明确。
对21例发生跳跃转移的胃癌患者的临床病理特征及术后预后进行评估，并与第1组（N1）或第2组（N2）淋巴结转移患者的结果进行比较。
在21例发生跳跃转移的患者中，9例患者肝总动脉旁淋巴结（第8a组）有转移，8例患者胃左动脉旁淋巴结（第7组）有转移，2例患者第7组和第8a组淋巴结有转移，1例患者脾门淋巴结（第10组）有转移，1例患者第10组淋巴结和脾动脉旁淋巴结（第11组）有转移。发生跳跃转移患者的肿瘤平均直径为5.7±2.4 cm，显著小于N1组患者（7.9±4.1 cm）和N2组患者（9.3±4.6 cm）。与N2组患者相比，发生跳跃转移患者的浆膜侵犯、淋巴管侵犯及腹膜转移发生率较低。发生跳跃转移患者、第1组淋巴结转移患者和第2组淋巴结转移患者的5年生存率分别为70.2%、62.0%和31.2%。第2组淋巴结转移患者的预后明显差于发生跳跃转移患者（P = 0.0029）或第1组淋巴结转移患者（P < 0.0001）。
我们的数据表明，发生跳跃转移患者的临床病理特征和预后与N1组淋巴结转移患者相似，但与N2组淋巴结转移患者不同。本研究中出现的跳跃转移部位可能是在胃癌中应用前哨淋巴结概念的关键。
