Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Ann Surg Oncol. 2013 May;20(5):1598-603. doi: 10.1245/s10434-012-2699-2. Epub 2012 Nov 2.
Multidetector-row computed tomography (MDCT) is widely used to predict pathological nodal status. However, an appropriate nodal size cutoff value to predict pathological nodal status has not been determined, and the impact of preoperative lymph node size on long-term outcomes is unclear.
This study included 137 gastric cancer patients with nodal involvement who underwent R0 gastrectomy between September 2002 and December 2006. Lymph nodes with a short-axis diameter of 10 mm or more as measured by MDCT were regarded as metastasized. An appropriate cutoff value with a high positive predictive value (PPV) and high specificity also was identified, and the subsequent clinicopathological characteristics and long-term outcomes were investigated.
A cutoff value of 15 mm was found to be appropriate for grouping patients into large (≥15 mm) and small (<15 mm) lymph node metastasis (LLNM and SLNM) groups, with a high PPV (98.6 %) and specificity (99.8 %). There were no differences in clinicopathological characteristics between the groups except for pathological nodal status. In the LLNM group, the 5-year survival rate was 55 %, which was significantly lower than in the SLNM group (73.2 %; P = 0.008). After stratification by tumor depth, the same trend was observed in patients with pT3 disease (46.8 % vs. 72.7 %; P = 0.015) and those with pT4 disease (14.3 % vs. 64.8 %; P = 0.035).
Gastric cancer patients with lymph nodes measuring 15 mm or more preoperatively have worse long-term outcomes. These patients would therefore be suitable candidates for future clinical trials investigating the efficacy of neoadjuvant chemotherapies.
多排螺旋 CT（MDCT）广泛用于预测病理性淋巴结状态。然而，尚未确定预测病理性淋巴结状态的适当淋巴结大小截断值，且术前淋巴结大小对长期预后的影响尚不清楚。
本研究纳入了 137 例于 2002 年 9 月至 2006 年 12 月期间接受 R0 胃切除术且存在淋巴结受累的胃癌患者。将 MDCT 测量的短轴直径≥10mm 的淋巴结视为转移淋巴结。确定了一个具有高阳性预测值（PPV）和高特异性的适当截断值，并对随后的临床病理特征和长期预后进行了研究。
发现 15mm 为合适的截断值，可将患者分为大（≥15mm）和小（＜15mm）淋巴结转移（LLNM 和 SLNM）组，其 PPV（98.6%）和特异性（99.8%）均较高。两组之间除了淋巴结状态外，临床病理特征无差异。在 LLNM 组中，5 年生存率为 55%，显著低于 SLNM 组（73.2%；P=0.008）。按肿瘤深度分层后，在 pT3 疾病患者（46.8% vs. 72.7%；P=0.015）和 pT4 疾病患者（14.3% vs. 64.8%；P=0.035）中也观察到了相同的趋势。
术前淋巴结直径≥15mm 的胃癌患者预后较差。这些患者可能适合参加未来研究新辅助化疗疗效的临床试验。
