Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK.
Histopathology. 2013 Sep;63(3):316-24. doi: 10.1111/his.12167. Epub 2013 Jul 9.
To examine factors that influence lymph node count and to study the relationship between nodal size and metastatic involvement in gastric cancer.
Observational study comparing lymph node retrieval by manual nodal dissection (MND) and systematic fat blocking (SFB) from 114 gastrectomy specimens. The influence of lymph node retrieval method, patient characteristics, oncological factors and surgical approach on lymph node count were examined using regression models. The risk-adjusted cumulative sum chart method was also used to analyse lymph node count. The lymph node count increased during the course of this study (P < 0.005). Both pathologist and lymph node retrieval method were independent predictors for lymph node count. MND yielded lower lymph node counts than SFB (58 versus 66, P < 0.05). The pathologist influenced lymph node retrieval by MND (R(2) : 0.297-0.518, P < 0.0001), but not SFB (R(2) : 0.340-0.344, P > 0.05). The percentage of positive lymph nodes below 5 mm was 24.2% and 44.1% for MND and SFB, respectively, resulting in cancer upstaging (P = 0.037).
Systematic fat blocking is associated with a higher total and positive lymph node yield compared to MND and is independent of the pathologist. Ignoring small lymph nodes can be a major cause for missing positive nodes, leading in turn to cancer down-staging.
探讨影响淋巴结计数的因素，并研究胃癌中淋巴结大小与转移受累之间的关系。
对 114 例胃癌标本进行手工淋巴结清扫（MND）和系统脂肪阻断（SFB）的观察性研究。使用回归模型检查淋巴结检索方法、患者特征、肿瘤因素和手术方法对淋巴结计数的影响。还使用风险调整累积和图法分析了淋巴结计数。在研究过程中，淋巴结计数增加（P<0.005）。病理学家和淋巴结检索方法均为独立的淋巴结计数预测因素。MND 的淋巴结计数低于 SFB（58 对 66，P<0.05）。MND 的病理学家影响淋巴结检索（R²：0.297-0.518，P<0.0001），但 SFB 则不受影响（R²：0.340-0.344，P>0.05）。MND 和 SFB 的<5mm 阳性淋巴结百分比分别为 24.2%和 44.1%，导致癌症分期上调（P=0.037）。
与 MND 相比，系统脂肪阻断与更高的总淋巴结和阳性淋巴结产量相关，且与病理学家无关。忽略小淋巴结可能是错过阳性淋巴结的主要原因，从而导致癌症分期下调。
