基于 pT1-2 期胃癌患者 1-3 个阳性淋巴结的前哨淋巴结概念的新见解。
A novel insight of sentinel lymph node concept based on 1-3 positive nodes in patients with pT1-2 gastric cancer.
机构信息
Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang 110001, PR China.
出版信息
BMC Cancer. 2011 Jan 17;11:18. doi: 10.1186/1471-2407-11-18.
BACKGROUND
Sentinel node (SN) biopsy has been practiced in gastric cancer in recent years, and many studies focused on the distribution of solitary lymph node metastasis (SLM) to assess the pattern of SN. In fact, there is usually more than one SN existing in gastric cancer. The distribution of SNs needs to be further re-evaluated.
METHODS
A total of 289 patients in pT1-2 stage with 1-3 positive nodes confined to same compartment were included in this study with informed consents. The primary lesion was solitary (≤ 5.0 cm in diameter) and D2 or D3 lymph node dissection had been performed. The location of metastatic lymph nodes was analyzed retrospectively.
RESULTS
Most positive nodes occurred in N1 compartment, with frequency of 79.6% to 85.7% based on site of tumor. In the lower third of stomach, no. 6 was the most common metastatic site and no. 3 was the second; the order was reversed for SLM. With increasing depth of tumor invasion, a progressively augmented nodal involvement was shown. Nearly a half appeared transverse metastasis when the tumor located at the lesser or greater curvature. Among skip metastasis, no. 7, 8a, 9 and 11p were the most common metastatic sites and the prognosis was as similar as that of patients with N1 involved only.
CONCLUSIONS
The 1-3 positive nodes in the same compartment should be possible SNs, and most of which are restricted in N1 in pT1-2 gastric cancer. Transversal and 2 stations lymph node metastasis are common.
背景
近年来，前哨淋巴结（SN）活检已应用于胃癌，许多研究集中于孤立性淋巴结转移（SLM）的分布，以评估 SN 的模式。事实上，胃癌通常存在多个 SN。SN 的分布需要进一步重新评估。
方法
本研究共纳入 289 例 T1-2 期且同一部位局限于 1-3 个阳性淋巴结且仅行 D2 或 D3 淋巴结清扫术的患者，均签署了知情同意书。原发病灶为单发（直径≤5.0cm）。回顾性分析转移性淋巴结的位置。
结果
大多数阳性淋巴结位于 N1 区，根据肿瘤部位，其发生率为 79.6%~85.7%。胃下 1/3 区，第 6 站是最常见的转移部位，第 3 站是第二常见部位；SLM 则相反。随着肿瘤浸润深度的增加，淋巴结受累的程度逐渐增加。当肿瘤位于小弯或大弯时，近一半出现横转移。跳跃转移中，第 7、8a、9 和 11p 站是最常见的转移部位，其预后与仅 N1 受累的患者相似。
结论
同一部位的 1-3 个阳性淋巴结可能是前哨淋巴结，且大多数局限于 pT1-2 期胃癌的 N1 区。横转移和 2 站淋巴结转移较为常见。
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