Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
BMC Cancer. 2010 Jan 29;10:25. doi: 10.1186/1471-2407-10-25.
Currently, the TNM staging system is a widely accepted method for assessing the prognosis of the disease and planning therapeutic strategies for cancer. Of the TNM system, the extent of lymph node involvement is the most important independent prognostic factor for gastric cancer. The aim of our study is to evaluate the survival and prognosis of gastric cancer patients with LN#12 or #13 involvement only and to assess the impact of anatomic regions of primary gastric tumor on survival in this particular subset of patients.
Among data of 1,008 stage IV gastric cancer patients who received curative R0 gastrectomy, a total of 79 patients with LN#12 (n = 68) and/or #13 (n = 11) were identified. All patients performed gastrectomy with D2 or D3 lymph node dissection.
In 79 patients with LN#12/13 involvement, the estimated one-, three- and five-year survival rate was 77.2%, 41.8% and 26.6% respectively. When we compared the patients with LN#12/13 involvement to those without involvement, there was no significant difference in OS (21.0 months vs. 25.0 months, respectively; P = 0.140). However, OS was significantly longer in patients with LN#12/13 involvement only than in those with M1 lymph node involvement (14.3 months; P = 0.001). There was a significant difference in survival according to anatomic locations of the primary tumor (lower to mid-body vs. high body or whole stomach): 26.5 vs. 9.2 months (P = 0.009). In Cox proportional hazard analysis, only N stage (p = 0.002) had significance to predict poor survival.
In this study we found that curatively resected gastric cancer patients with pathologic involvement of LN #12 and/or LN #13 had favorable survival outcome, especially those with primary tumor location of mid-body to antrum. Prospective analysis of survival in gastric cancer patients with L N#12 or #13 metastasis is warranted especially with regards to primary tumor location.
目前，TNM 分期系统是评估疾病预后和制定癌症治疗策略的广泛接受的方法。在 TNM 系统中，淋巴结受累程度是胃癌最重要的独立预后因素。我们的研究目的是评估仅累及 LN#12 或#13 的胃癌患者的生存和预后，并评估原发胃肿瘤解剖区域对这一特定患者亚组生存的影响。
在 1008 例接受根治性 R0 胃切除术的 IV 期胃癌患者中，共发现 79 例 LN#12（n=68）和/或#13（n=11）患者。所有患者均行 D2 或 D3 淋巴结清扫术。
在 79 例 LN#12/13 受累的患者中，估计 1 年、3 年和 5 年生存率分别为 77.2%、41.8%和 26.6%。当我们将 LN#12/13 受累患者与无受累患者进行比较时，OS 无显著差异（21.0 个月与 25.0 个月，P=0.140）。然而，与淋巴结 M1 受累患者相比，仅 LN#12/13 受累患者的 OS 明显更长（14.3 个月，P=0.001）。原发肿瘤解剖部位对生存有显著影响（胃体下部至体中部与胃体上部或全胃相比）：26.5 个月与 9.2 个月（P=0.009）。在 Cox 比例风险分析中，只有 N 分期（p=0.002）对预测不良预后有意义。
在这项研究中，我们发现，病理上累及 LN#12 和/或 LN#13 的可治愈性切除胃癌患者有良好的生存结果，特别是那些原发肿瘤位于胃体下部至胃窦部的患者。需要对 LN#12 或#13 转移的胃癌患者的生存进行前瞻性分析，特别是要考虑原发肿瘤的位置。
