Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
Eur J Surg Oncol. 2012 Apr;38(4):319-25. doi: 10.1016/j.ejso.2011.12.016. Epub 2012 Jan 17.
While it is suggested that more than 15 lymph nodes (LNs) should be evaluated for accurate staging of gastric cancer, LN yield in western countries is generally low. The effect of preoperative chemotherapy on LN yield in gastric cancer is unknown. The aim of the present study is to determine whether preoperative chemotherapy is associated with any difference in the number of LNs obtained from specimens of patients who underwent curative surgery for gastric adenocarcinoma.
In 1205 patients from Memorial Sloan-Kettering Cancer Center (MSKCC) and 1220 patients from the Netherlands Cancer Registry (NCR) who underwent a gastrectomy with curative intent for gastric adenocarcinoma without receiving preoperative radiotherapy, LN yield was analyzed, comparing patients who received preoperative chemotherapy and patients who received no preoperative therapy.
Of the 2425 patients who underwent a gastrectomy, 14% received preoperative chemotherapy. Median LN yields were 23 at MSKCC and 10 in the NCR. Despite this twofold difference in LN yield between the two populations, with multivariate Poisson regression, chemotherapy was not associated with LN yield of either population. Variables associated with increased LN yield were institution, female sex, lower age, total (versus distal) gastrectomy and increasing T-stage.
In this patient series, treatment at MSKCC, female sex, lower age, total gastrectomy and increasing primary tumor stage were associated with a higher number of evaluated LNs. Preoperative chemotherapy was not associated with a decrease in LN yield. Evaluating more than 15 LNs after gastrectomy is feasible, with or without preoperative chemotherapy.
虽然有研究表明，为了准确分期胃癌，应评估超过 15 个淋巴结（LN），但西方国家的 LN 检出率通常较低。术前化疗对胃癌 LN 检出率的影响尚不清楚。本研究旨在确定术前化疗是否与接受根治性胃腺癌手术患者标本中获得的 LN 数量存在差异有关。
在 Memorial Sloan-Kettering 癌症中心（MSKCC）的 1205 例患者和荷兰癌症登记处（NCR）的 1220 例接受根治性胃切除术且未接受术前放疗的胃腺癌患者中，分析了 LN 检出量，比较了接受术前化疗和未接受术前治疗的患者。
在接受胃切除术的 2425 例患者中，14%接受了术前化疗。MSKCC 的中位 LN 检出量为 23 个，NCR 为 10 个。尽管这两个人群的 LN 检出量存在两倍的差异，但多变量泊松回归分析显示，化疗与两个人群的 LN 检出量均无关。与 LN 检出量增加相关的变量包括机构、女性、年龄较小、全胃切除术和 T 分期增加。
在本患者系列中，MSKCC 治疗、女性、年龄较小、全胃切除术和原发肿瘤分期增加与评估的 LN 数量增加相关。术前化疗与 LN 检出量减少无关。无论是否接受术前化疗，在胃切除术后评估 15 个以上的 LN 是可行的。
