Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan.
Ann Surg Oncol. 2013 Jul;20(7):2290-5. doi: 10.1245/s10434-012-2839-8. Epub 2013 Jan 9.
Whether gastrectomy with D2 lymphadenectomy improves survival of patients with advanced gastric cancer (AGC) remains controversial. Few studies have described the pathological features of AGC with metastatic suprapancreatic lymph nodes (LN), which are the target of D2 lymphadenectomy. This study therefore aims to clarify the prognosis and clinical pathological features including the number and location of metastatic LN in AGC with metastatic suprapancreatic LN.
406 patients with AGC, who underwent gastrectomy with D2 lymphadenectomy from 1982 to 2007 at Oita University, were reviewed retrospectively with regard to presence or absence of metastatic suprapancreatic LN. The pathological factors associated with AGC with metastatic suprapancreatic LN were examined by univariate and multivariate analysis.
Of 362 patients with AGC, 78 had suprapancreatic LN metastasis (21.5 %), differing significantly in terms of presence of vascular invasion and having a larger number of metastatic perigastric LN in comparison with only metastatic perigastric LN on univariate analysis. According to multivariate analysis, they were associated with presence of vascular invasion and a large number of total metastatic LN (more than two; N2≤). The overall 5-year survival rate of the AGC with perigastric LN metastasis (station 1-7) group was 37.9 % and of the AGC with suprapancreatic LN metastasis group was 12.8 %. There were significant differences in each group (P < 0.05).
Patients with AGC with metastatic suprapancreatic LN had a large number of total metastatic LN and poor prognosis, suggesting that it may be a systemic disease.
胃切除术加 D2 淋巴结清扫术是否能提高晚期胃癌（AGC）患者的生存率仍存在争议。很少有研究描述过具有转移性胰上淋巴结（LN）的 AGC 的病理特征，而这些淋巴结是 D2 淋巴结清扫术的目标。因此，本研究旨在阐明具有转移性胰上 LN 的 AGC 的预后和临床病理特征，包括转移性 LN 的数量和位置。
回顾性分析了 1982 年至 2007 年在大分大学接受胃切除术加 D2 淋巴结清扫术的 406 例 AGC 患者，以确定是否存在转移性胰上 LN。通过单因素和多因素分析，研究了与具有转移性胰上 LN 的 AGC 相关的病理因素。
在 362 例 AGC 患者中，78 例有胰上 LN 转移（21.5%），与仅具有胃周 LN 转移（站 1-7）的患者相比，在单因素分析中，这些患者具有血管侵犯和更多的胃周转移性 LN。根据多因素分析，它们与血管侵犯和大量总转移性 LN（超过 2 个；N2≤）的存在相关。仅具有胃周 LN 转移（站 1-7）的 AGC 患者的 5 年总生存率为 37.9%，而具有胰上 LN 转移的 AGC 患者的 5 年总生存率为 12.8%。两组间差异有统计学意义（P < 0.05）。
具有转移性胰上 LN 的 AGC 患者具有大量的总转移性 LN 和较差的预后，表明其可能是一种全身性疾病。
