Yonsei University College of Medicine, Seoul, Republic of Korea.
Radiother Oncol. 2012 Sep;104(3):367-73. doi: 10.1016/j.radonc.2012.08.017. Epub 2012 Sep 13.
To analyze patterns of regional recurrence after curative gastrectomy and D2 lymph node dissection in patients with stage III (N3) gastric cancer.
Between 2004 and 2008, 2918 patients with primary gastric cancer underwent D2 resection at a single institution. A retrospective review was performed on 382 patients in stage III with N3 disease. Of these, 357 patients (93.5%) received adjuvant chemotherapy. None of the patients received pre- or postoperative radiotherapy.
Median follow-up was 56.3 months. The 5-year regional failure free-survival (RFFS) rate was 63.6%. Regional failure (RF) as any component of first recurrence occurred in 91 patients (23.8%), with isolated regional failure occurring in 49 (12.8%). The most commonly involved lymph nodes were the No. 16b, No. 16a, No. 12, No. 14, No. 13, and No. 9 nodes. RFFS was adversely affected by advanced nodal stage (N3b vs. N3a). The 5-year progression-free survival rate was 32.1% and overall survival was 41.5%.
The most prevalent nodal recurrence in patients with advanced gastric cancer was in the nodal basin outside the D2 dissection field. Our findings may help physicians construct a lymph node target volume for radiation treatment of gastric cancer after D2 dissection.
分析根治性胃切除术后和 D2 淋巴结清扫术治疗 III 期（N3）胃癌患者的区域复发模式。
2004 年至 2008 年间，2918 例原发性胃癌患者在一家机构接受了 D2 切除术。对 382 例 III 期 N3 期疾病患者进行了回顾性分析。其中 357 例（93.5%）患者接受了辅助化疗。所有患者均未接受术前或术后放疗。
中位随访时间为 56.3 个月。5 年区域无复发生存率（RFFS）为 63.6%。91 例（23.8%）患者出现任何形式的首次复发区域失败，其中孤立性区域失败 49 例（12.8%）。最常累及的淋巴结是 No.16b、No.16a、No.12、No.14、No.13 和 No.9 淋巴结。区域复发（RF）是影响 RFFS 的不利因素（N3b 比 N3a）。5 年无进展生存率为 32.1%，总生存率为 41.5%。
晚期胃癌患者最常见的淋巴结复发位于 D2 清扫区域以外的淋巴结区域。我们的发现可能有助于医生为 D2 清扫术后胃癌的放射治疗构建淋巴结靶区。
