Department of Surgery, Eulji General Hospital, Eulji University School of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2014 Mar;21(3):899-907. doi: 10.1245/s10434-013-3403-x. Epub 2013 Nov 26.
Currently, gastric cancer staging systems do not consider the anatomic extent of metastatic lymph nodes (mLNs) as a prognostic factor. We therefore investigated the prognostic impact of the anatomic extent of mLNs on gastric cancer.
The prognoses of 4,043 gastric cancer patients who underwent curative resection were analyzed. Patients with mLNs in lymph node (LN) stations 1-6 (n = 1,980) comprised the perigastric LN-positive (PLN) group, and patients with mLNs in LN stations 7-12 and 14 (n = 2,063) were assigned to the extraperigastric LN-positive (ELN) group. Overall survival was estimated using the Kaplan-Meier method, and hazard ratios (HRs) were calculated by the Cox proportional hazard model.
The ELN group exhibited worse survival than the PLN group (p < 0.001), although there were differences in their clinicopathological features. When patients were stratified according to tumor-node-metastasis stage, the ELN groups had unfavorable prognoses compared with the PLN groups (p < 0.05). There were significant differences in long-term survival when the nodal stage of the current staging systems were subdivided according to anatomic nodal extent (p < 0.05), although there was a strong association between the probability of having extraperigastric mLNs and N classification. In multivariate analysis using age, gender, tumor size, tumor location, histology, T classification, and the extent of mLNs as covariates, presence of extraperigastric mLNs was an independent prognostic factor (HR 1.89, 95 % CI 1.73-2.07), along with age, tumor size, tumor location, and T classification.
The anatomic extent of mLNs significantly affects patient prognosis. Including the anatomic extent of mLNs in the current staging system may predict gastric cancer prognosis more accurately in patients with the same stage of cancer.
目前，胃癌分期系统并未将转移性淋巴结（mLN）的解剖范围作为预后因素。因此，我们研究了 mLN 的解剖范围对胃癌的预后影响。
分析了 4043 例接受根治性切除术的胃癌患者的预后。mLN 位于淋巴结（LN）站 1-6（n=1980）的患者归入胃周淋巴结阳性（PLN）组，mLN 位于 LN 站 7-12 和 14 的患者归入胃外淋巴结阳性（ELN）组。使用 Kaplan-Meier 方法估计总生存率，并用 Cox 比例风险模型计算危险比（HR）。
ELN 组的生存情况较 PLN 组差（p<0.001），尽管两组的临床病理特征存在差异。根据肿瘤-淋巴结-转移分期对患者进行分层时，ELN 组的预后较 PLN 组差（p<0.05）。根据解剖淋巴结范围对当前分期系统的淋巴结分期进行细分时，长期生存率存在显著差异（p<0.05），尽管胃外淋巴结的存在概率与 N 分类之间存在很强的关联。在使用年龄、性别、肿瘤大小、肿瘤位置、组织学、T 分类和 mLN 范围作为协变量的多变量分析中，存在胃外 mLN 是独立的预后因素（HR 1.89，95%CI 1.73-2.07），与年龄、肿瘤大小、肿瘤位置和 T 分类一起。
mLN 的解剖范围显著影响患者的预后。将 mLN 的解剖范围纳入当前的分期系统可能会更准确地预测具有相同癌症分期的患者的胃癌预后。
