Catarci Marco, Montemurro Leonardo Antonio, Di Cintio Antonio, Ghinassi Sabrina, Coppola Luigi, Pinnarelli Luigi, Belardi Augusto, Koch Maurizio, Grassi Giovanni Battista
Department of Surgery, San Filippo Neri Hospital, Rome, Italy,
Updates Surg. 2010 Oct;62(2):89-99. doi: 10.1007/s13304-010-0017-8.
The optimal degree of lymph node dissection for gastric cancer is still matter of debate. Particularly, there are serious doubts about the reproducibility of extended lymph node dissection in western surgical units, and no studies to date have investigated factors influencing lymph node retrieval and examination during the learning curve. Univariate and multivariate retrospective analysis of 21 variables were carried out on a prospective series of 313 consecutive resections for gastric cancer performed by ten different surgeons, with lymph node retrieval and analysis performed by ten different pathologists. Endpoints were number of examined lymph nodes per patient, number of cases with inadequate nodal staging (<15 examined lymph nodes) and lymph node ratio (calculated as the absolute ratio between the number of metastatic and the number of examined lymph nodes). The number of examined lymph nodes per patient (mean ± SD 28.3 ± 14.1, median 26, range 2-78) was independently influenced by age, pN status, the type of gastric resection, the degree of lymph node dissection and single pathologist. There were 47 cases (15.0%) with incomplete nodal staging that was independently determined by the degree of lymph node dissection and by the pathologist. Lymph node ratio was independently influenced by the number of metastatic lymph nodes, the disease stage and by the histological subtype of the tumor. The role of an experienced or dedicated pathologist should not be underevaluated in western series when dealing with lymph node retrieval and examination. Lymph node ratio appeared not to be significantly influenced by the number of examined lymph nodes, being independently influenced only by the number of metastatic lymph nodes, the disease stage and by the histological subtype of the tumor. It could be therefore tested as a prognostic factor limiting the stage-migration phenomenon induced by extended lymph node dissection.
胃癌淋巴结清扫的最佳程度仍是一个有争议的问题。特别是，西方外科单位扩大淋巴结清扫的可重复性存在严重疑问，而且迄今为止尚无研究调查学习曲线期间影响淋巴结获取和检查的因素。对由十位不同外科医生连续进行的313例胃癌切除术的前瞻性系列进行了21个变量的单因素和多因素回顾性分析，淋巴结获取和分析由十位不同病理学家进行。观察终点为每位患者检查的淋巴结数量、淋巴结分期不足（检查的淋巴结<15个）的病例数以及淋巴结比率（计算为转移淋巴结数量与检查淋巴结数量的绝对比率）。每位患者检查的淋巴结数量（均值±标准差28.3±14.1，中位数26，范围2 - 78）受年龄、pN状态、胃切除术类型、淋巴结清扫程度和单一病理学家的独立影响。有47例（15.0%）淋巴结分期不完整，这由淋巴结清扫程度和病理学家独立确定。淋巴结比率受转移淋巴结数量、疾病分期和肿瘤组织学亚型的独立影响。在西方系列中，在处理淋巴结获取和检查时，经验丰富或专门的病理学家的作用不应被低估。淋巴结比率似乎不受检查淋巴结数量的显著影响，仅受转移淋巴结数量、疾病分期和肿瘤组织学亚型的独立影响。因此，它可以作为一个预后因素进行检测，以限制扩大淋巴结清扫引起的分期迁移现象。
