Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
Cancer. 2010 Jan 15;116(2):309-15. doi: 10.1002/cncr.24764.
Lymphatic spread is 1 of the most relevant prognostic factors for gastric carcinoma. The current International Union Against Cancer (UICC) pN staging system is based on the number of metastatic lymph nodes and does not take into consideration the characteristics of the metastatic lymph nodes itself. The aim of the current study was to examine the prognostic value of extracapsular lymph node involvement in gastric cancer and to find correlations with clinicopathological parameters.
Tissue samples were obtained from 159 gastric cancer patients who underwent gastrectomy with D2-lymphadenectomy in 142 (89.3%) cases and subtotal gastrectomy with D2-lymphadenectomy in 17 (10.7%) cases. The number of resected lymph nodes, number of metastatic lymph nodes, and number of metastatic lymph nodes with extracapsular lymph node involvement were determined. Extracapsular spread was defined as infiltration of cancer cells beyond the capsule of the metastatic lymph node.
Ninety-six (60.4%) patients had lymph node metastasis. In 57 (35.8%) cases, extracapsular lymph node involvement was also detected. Extracapsular lymph node involvement was significantly associated with higher pN-category (P < .001), higher pM category (P = .048), and higher UICC stages (P = .001). According to the Kaplan-Meier log-rank statistical method, extracapsular lymph node involvement was significantly associated with poor survival (P = .001). In the multivariate analysis besides pT (P < .001) and R-category (P = .009), extracapsular lymph node involvement also remained as an independent prognostic factor (P = .003), whereas the UICC pN-category (P = .822) lost its prognostic value.
Extracapsular lymph node involvement is associated with higher tumor stages and is an independent negative prognostic factor in gastric cancer. In future staging systems for gastric cancer, extracapsular lymph node involvement should be considered.
淋巴转移是胃癌最重要的预后因素之一。目前的国际抗癌联盟（UICC）pN 分期系统基于转移淋巴结的数量，并未考虑转移淋巴结本身的特征。本研究旨在探讨胃癌淋巴结包膜外侵犯的预后价值，并寻找与临床病理参数的相关性。
从 159 名接受胃切除术伴 D2 淋巴结清扫术的胃癌患者（142 例，89.3%）和接受胃大部切除术伴 D2 淋巴结清扫术的 17 名患者（10.7%）中获取组织样本。确定切除的淋巴结数量、转移淋巴结数量和包膜外转移淋巴结数量。包膜外扩散定义为癌细胞浸润转移淋巴结包膜外。
96 例（60.4%）患者发生淋巴结转移。57 例（35.8%）患者检测到淋巴结包膜外侵犯。淋巴结包膜外侵犯与更高的 pN 分期（P <.001）、更高的 pM 分期（P =.048）和更高的 UICC 分期（P =.001）显著相关。根据 Kaplan-Meier 对数秩检验统计方法，淋巴结包膜外侵犯与不良生存显著相关（P =.001）。在多因素分析中，除了 pT（P <.001）和 R 分期（P =.009）外，淋巴结包膜外侵犯仍然是独立的预后因素（P =.003），而 UICC pN 分期（P =.822）失去了其预后价值。
淋巴结包膜外侵犯与较高的肿瘤分期相关，是胃癌的独立预后不良因素。在未来的胃癌分期系统中，应考虑淋巴结包膜外侵犯。
