Ozgüç Halil, Sönmez Yalçin, Yerci Omer
Department of Surgery, Uludag University, School of Medicine, Bursa, Turkey.
Turk J Gastroenterol. 2008 Mar;19(1):2-7.
BACKGROUND/AIMS: Many studies have shown that the metastatic lymph node ratio, calculated by dividing the number of metastatic lymph nodes by the total number of lymph nodes, is an important prognostic factor in gastric cancer. In the present study, the applicability of the metastatic in the 1997 Tumor Node Metastasis system was investigated using our clinical data and discussed in light of the literature.
The study was performed on the 166 patients with gastric cancer in whom R0 resection could be performed and more than 15 nodes were resected. The possible effects of age, gender, location, type of resection, number of resected lymph nodes, depth of invasion, number of involved lymph nodes, tumor grade and metastatic on survival were analyzed.
There was a direct correlation between the total number of nodes and the number of metastatic nodes (r: 0.319, p<0.0001). However, there was no correlation between metastatic and the total number of nodes (r: 0.0072, p: 0.354). Tumor location, size, depth of invasion, number of involved nodes and metastatic were found to be determinants of survival in univariate analysis. Cox regression analysis identified metastatic as the only independent prognostic factor.
A new staging system based on metastatic will be resistant to stage migration and will include the surgical approach in staging. However, further studies are required to determine appropriate cutoff values and the best approach to patients with less than 15 resected nodes.
背景/目的：许多研究表明，转移淋巴结比率（通过转移淋巴结数量除以淋巴结总数计算得出）是胃癌的一个重要预后因素。在本研究中，利用我们的临床数据对1997年肿瘤-淋巴结-转移（TNM）系统中转移情况的适用性进行了调查，并结合文献进行了讨论。
对166例可进行R0切除且切除淋巴结超过15枚的胃癌患者进行了研究。分析了年龄、性别、肿瘤位置、切除类型、切除淋巴结数量、浸润深度、受累淋巴结数量、肿瘤分级及转移情况对生存的可能影响。
淋巴结总数与转移淋巴结数量之间存在直接相关性（r：0.319，p<0.0001）。然而，转移情况与淋巴结总数之间无相关性（r：0.0072，p：0.354）。在单因素分析中，肿瘤位置、大小、浸润深度、受累淋巴结数量及转移情况被发现是生存的决定因素。Cox回归分析确定转移情况是唯一的独立预后因素。
基于转移情况的新分期系统将对分期迁移具有抗性，并将在分期中纳入手术方式。然而，需要进一步研究以确定合适的临界值以及针对切除淋巴结少于15枚患者的最佳方法。
