Huang Chang-Ming, Lin Jian-Xian, Zheng Chao-Hui, Li Ping, Xie Jian-Wei, Wang Jia-Bin
Department of Surgical Oncology, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wai Ke Za Zhi. 2010 Aug 1;48(15):1125-9.
To investigate the prognostic impacts of number of all dissected and negative lymph nodes (LNs) in gastric cancer after curative distal gastrectomy.
This study involved 634 patients with gastric cancer, who underwent curative resection with distal gastrectomy from January 1995 to November 2004. Long-term surgical outcomes and associations between dissected LN counts or negative LN counts with the 5-year survival rate were investigated.
In this group, 591 patients (93.2%) was followed-up for 5 - 14 years, the median survival was 62.0 months. The 5-year survival of the entire cohort was 57.6%. The number of negative LNs was positively correlated with the retrieved nodes count on the Pearson's correlation test (P < 0.05). Cox regression analysis showed that depth of tumor invasion, LN involvement, negative LN count and dissected LN count were independent predictors of survival (P < 0.05). Among patients with comparable TNM ranks, the overall survival rate was significantly different among patients with different dissected LN counts or negative LN counts. For each 10 extra LNs added to the total LN count, the calculated overall survival rate increased by: 14.2% (stage I), 20.5% (stage II), 17.5% (stage III), 10.9% (stage IV) and 13.1% (entire cohort). While, for each 10 extra negative LNs added to negative LN counts, the overall survival rate increased by: 20.1% (stage I), 18.8% (stage II), 18.4% (stage III), 18.0% (stage IV) and 19.2% (entire cohort).
The number of dissected LNs and negative LNs are independent predictors of survival for gastric cancer. More LNs should be resected in patients receiving curative distal gastrectomy to improve prognosis.
探讨根治性远端胃切除术后胃癌患者清扫淋巴结总数及阴性淋巴结数对预后的影响。
本研究纳入了1995年1月至2004年11月期间接受根治性远端胃切除术的634例胃癌患者。研究了长期手术结果以及清扫淋巴结数或阴性淋巴结数与5年生存率之间的关联。
该组中，591例患者（93.2%）接受了5至14年的随访，中位生存期为62.0个月。整个队列的5年生存率为57.6%。在Pearson相关性检验中，阴性淋巴结数与清扫淋巴结数呈正相关（P < 0.05）。Cox回归分析显示，肿瘤浸润深度、淋巴结受累情况、阴性淋巴结数和清扫淋巴结数是生存的独立预测因素（P < 0.05）。在TNM分期相当的患者中，不同清扫淋巴结数或阴性淋巴结数的患者总体生存率存在显著差异。每增加10个淋巴结到总淋巴结数中，计算得出的总体生存率提高：I期为14.2%，II期为20.5%，III期为17.5%，IV期为10.9%，整个队列中为13.1%。而每增加10个阴性淋巴结到阴性淋巴结数中，总体生存率提高：I期为20.1%，II期为18.8%，III期为18.4%，IV期为18.0%，整个队列中为19.2%。
清扫淋巴结数和阴性淋巴结数是胃癌生存的独立预测因素。接受根治性远端胃切除术的患者应切除更多淋巴结以改善预后。
