Tokunaga Masanori, Ohyama Shigekazu, Hiki Naoki, Fukunaga Tetsu, Inoue Harutaka, Yamada Kazuhiko, Sano Takeshi, Yamaguchi Toshiharu, Nakajima Toshifusa
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg Oncol. 2009 May;16(5):1241-6. doi: 10.1245/s10434-009-0345-4. Epub 2009 Feb 18.
In advanced gastric cancer (AGC) with duodenum invasion, the posterior pancreatic lymph nodes are susceptible to metastasis because of their proximity to the duodenum. The therapeutic value of lymph node dissection in this area for AGC with macroscopic duodenum invasion remains unclear.
Patients who had undergone curative gastrectomy for lower-third AGC from 1970 to 2004 at the Cancer Institute Hospital were recruited for this study. Clinicopathological data were collected retrospectively, and compared between cases of AGC with duodenum invasion (AGC-DI group) and AGC without duodenum invasion (AGC-nDI group). In the AGC-DI group, the therapeutic value of lymph node dissection was evaluated using a therapeutic index (multiplication of the frequency of metastasis to the station by the 5-year survival rate of patients with metastasis to that station).
The AGC-DI group generally had tumors of higher pathological stage, which might account for the poorer 5-year survival rate compared with that of the AGC-nDI group (50.1% versus 68.5%; P = 0.0002). The incidence of lymph node metastasis was higher in the AGC-DI group than that in the AGC-nDI group, including nodes in the posterior pancreatic head (23.9% versus 7.0%, P < 0.0001). In the AGC-DI group, posterior pancreatic head lymph node dissection was of therapeutic value (4.19) equivalent to dissection of second-tier lymph nodes.
The dissection of posterior pancreatic head lymph nodes might be effective in AGC with macroscopic duodenum invasion since this has therapeutic value equivalent to that of second-tier lymph node dissection and might improve patients' long-term outcomes.
在伴有十二指肠侵犯的进展期胃癌（AGC）中，胰后淋巴结因其靠近十二指肠而易于发生转移。对于伴有十二指肠肉眼侵犯的AGC，该区域淋巴结清扫的治疗价值仍不明确。
本研究纳入了1970年至2004年在癌症研究所医院接受了根治性胃切除术治疗下三分之一AGC的患者。回顾性收集临床病理数据，并在伴有十二指肠侵犯的AGC病例（AGC-DI组）和不伴有十二指肠侵犯的AGC病例（AGC-nDI组）之间进行比较。在AGC-DI组中，使用治疗指数（转移至该站的频率乘以转移至该站患者的5年生存率）评估淋巴结清扫的治疗价值。
AGC-DI组通常具有更高病理分期的肿瘤，这可能是其5年生存率低于AGC-nDI组的原因（50.1%对68.5%；P = 0.0002）。AGC-DI组的淋巴结转移发生率高于AGC-nDI组，包括胰头后淋巴结（23.9%对7.0%，P < 0.0001）。在AGC-DI组中，胰头后淋巴结清扫具有与二级淋巴结清扫相当的治疗价值（4.19）。
胰头后淋巴结清扫对于伴有十二指肠肉眼侵犯的AGC可能有效，因为其具有与二级淋巴结清扫相当的治疗价值，可能改善患者的长期预后。
