Huang Chang-Ming, Lin Jian-Xian, Zheng Chao-Hui, Li Ping, Xie Jian-Wei, Lin Bi-Juan, Lu Hui-Shan
Department of Oncology, Affiliated Union Hospital, Fujian Medical University, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China.
World J Gastroenterol. 2009 Aug 21;15(31):3926-30. doi: 10.3748/wjg.15.3926.
To investigate the long-term effect of the number of resected lymph nodes (LNs) on the prognosis of patients with node-negative gastric cancer.
Clinical data of 211 patients with gastric cancer, without nodal involvement, were analyzed retrospectively after D2 radical operation. We analyzed the relationship between the number of resected LNs with the 5-year survival, the recurrence rate and the post-operative complication rate.
The 5-year survival of the entire cohort was 82.2%. The total number of dissected LNs was one of the independent prognostic factors. Among patients with comparable depth of invasion, the larger the number of resected LNs, the better the survival (P < 0.05). A cut-point analysis provided the possibility to detect a significant survival difference among subgroups. Patients had a better long-term survival outcomes with LN counts > or = 15 for pT1-2, > or = 20 for pT3-4, and > or = 15 for the entire cohort. The overall recurrence rate was 29.4% within 5 years after surgery. There was a statistically significant, negative correlation between the number of resected LNs and the recurrence rate (P < 0.01). The post-operative complication rate was 10.9% and was not significantly correlated with the number of dissected LNs (P > 0.05).
For node-negative gastric cancer, sufficient number of dissected LNs is recommended during D2 lymphadenectomy, to improve the long-term survival and reduce the recurrence. Suitable increments of the dissected LN count would not increase the post-operative complication rate.
探讨淋巴结清扫数量对无淋巴结转移的胃癌患者预后的长期影响。
回顾性分析211例行D2根治性手术的无淋巴结转移的胃癌患者的临床资料。分析清扫淋巴结数量与5年生存率、复发率及术后并发症发生率之间的关系。
整个队列的5年生存率为82.2%。清扫淋巴结总数是独立的预后因素之一。在浸润深度相当的患者中，清扫淋巴结数量越多，生存率越高（P<0.05）。切点分析为检测亚组间显著的生存差异提供了可能。对于pT1-2期患者，淋巴结计数≥15个、pT3-4期患者≥20个、整个队列患者≥15个时，患者的长期生存结局更佳。术后5年内总复发率为29.4%。清扫淋巴结数量与复发率之间存在统计学上显著的负相关（P<0.01）。术后并发症发生率为10.9%，与清扫淋巴结数量无显著相关性（P>0.05）。
对于无淋巴结转移的胃癌患者，建议在D2淋巴结清扫术中清扫足够数量的淋巴结，以提高长期生存率并降低复发率。适当增加清扫淋巴结数量不会增加术后并发症发生率。
