Research Branch, First Affiliated Hospital of China Medical University, Shenyang, China.
J Surg Oncol. 2012 Jun 15;105(8):805-12. doi: 10.1002/jso.23011. Epub 2011 Dec 27.
To investigate the validity of gastric cancers with nodes metastasis at Level II stations limited to No. 7 being classified as level-based n1 stage disease and the impact of this revision on lymph node staging.
Clinicopathologic features and prognosis of 1,606 node positive gastric cancers were retrospectively reviewed. Four patient groups were classified according to the status of node involvement: Group A, 734 patients with node metastasis at Level I stations; Group B, 317 patients with nodes metastasis at Level II stations limited to No. 7; Group C, 501 patients with nodes metastasis at Level II stations besides No. 7; and Group D, 54 patients with nodes metastasis at Level III stations.
Although the extent of node metastasis for patients in Group B was more severe than that for patients in Group A, clinicopathologic features (especially pT stage) were not significantly different. Although overall survival for patients in Group B was significantly worse than that for patients in Group A, no significant differences in prognosis could be observed when stratified by pN or rN category. A revised level-based n category was established by considering cancers in Group B as level-based n1 stage disease. Multivariate analysis confirmed rN category and the revised level-based n category independently predicted patients' survival. A novel N category was established by combining rN category and the revised level-based n category. Further analysis revealed the novel N category had better homogeneity, discriminatory ability, and monotonicity of gradients than the other node categories, indicating the novel N system might be the most valuable node staging system for prognostic assessment.
It might be more suitable for cancers in Group B being classified as level-based n1 stage disease. And we recommend the anatomical location of metastatic lymph nodes also being considered in the categorization of lymph node metastasis.
探讨将局限于第 7 站的 II 区淋巴结转移的胃癌病例归类为基于水平的 n1 期疾病的有效性，以及这一修订对淋巴结分期的影响。
回顾性分析了 1606 例淋巴结阳性胃癌患者的临床病理特征和预后。根据淋巴结受累情况，将 4 组患者分为：A 组，734 例 I 区淋巴结转移患者；B 组，317 例局限于第 7 站的 II 区淋巴结转移患者；C 组，501 例除第 7 站以外的 II 区淋巴结转移患者；D 组，54 例 III 区淋巴结转移患者。
尽管 B 组患者的淋巴结转移程度比 A 组严重，但临床病理特征（尤其是 pT 分期）无显著差异。尽管 B 组患者的总体生存率明显差于 A 组，但按 pN 或 rN 分类，预后无显著差异。通过将 B 组病例归类为基于水平的 n1 期疾病，建立了一个基于水平的新 n 分类。多因素分析证实 rN 分类和基于水平的新 n 分类独立预测患者的生存。通过结合 rN 分类和基于水平的新 n 分类建立了一个新的 N 分类。进一步分析显示，新的 N 分类具有更好的同质性、判别能力和梯度单调性，表明新的 N 系统可能是最有价值的用于预后评估的淋巴结分期系统。
将 B 组病例归类为基于水平的 n1 期疾病可能更为合适。并且建议在淋巴结转移的分类中也考虑转移淋巴结的解剖位置。
