[D2淋巴结清扫联合腹主动脉旁淋巴结清扫对N3期胃癌的预后影响]

[The prognostic influence of D2 lymphadenectomy with para-aortic lymph nodal dissection for gastric cancer in N3 stage].

作者信息

Liang Yue-xiang, Liang Han, Ding Xue-wei, Wang Xiao-na, Zhang Li, Wu Liang-liang, Liu Hong-gen, Jiao Xu-guang

机构信息

Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2013 Dec;51(12):1071-6.

PMID:24499714

Abstract

OBJECTIVE

To elucidate the necessity of para-aortic lymph nodal dissection in D2 lymphadenectomy for gastric cancer in N3 stage.

METHODS

A total of 278 gastric cancer patients staged N3 who underwent gastrectomy between January 2003 and December 2007 were enrolled. There were 180 male and 98 female patients, and the patients' age were 26-93 years (median was 61 years). All patients had undergone surgical treatment. There were R0 resection in 246 cases and R1 resection in 32 cases. Lymph node dissection included D1 lymphadenectomy with 125 cases, D2 lymphadenectomy with 109 cases and D2+para-aortic lymph nodal dissection(PAND) with 44 cases. The surgical approach were total gastrectomy (98 cases) and subtotal gastrectomy (180 cases). Potential prognostic factors were analyzed.

RESULTS

The lymph node metastasis of each station was high in gastric cancer patients staged N3 and 34.1% patients had the para-aortic lymph nodal metastasis. Borrmann type (HR = 1.350, 95%CI: 1.018-1.790, P = 0.037), curability (HR = 1.580, 95%CI: 1.076-2.322, P = 0.020), depth of invasion (HR = 1.697, 95%CI: 1.005-2.864, P = 0.048), metastatic lymph node ratio (HR = 1.631, 95%CI: 1.261-2.111, P = 0.000), extranodal metastasis (HR = 1.336, 95%CI: 1.027-1.738, P = 0.031), postoperative adjuvant chemotherapy (HR = 1.312, 95%CI: 1.015-1.696, P = 0.038), extent of lymphadenectomy (HR = 1.488 and 2.114, P = 0.054 and 0.000) and number of retrieved lymph node (HR = 1.503 and 2.112, P = 0.025 and 0.000) were found to be factors correlated to overall survival. In multivariate analysis, only Borrmann type (HR = 1.399, 95%CI: 1.050-1.863, P = 0.022), metastatic lymph node ratio (HR = 1.353, 95%CI: 1.016-1.802, P = 0.039) and extent of lymphadenectomy (HR = 1.725, 95%CI: 1.111-2.678, P = 0.015) were independent prognostic factors for gastric cancer patients in N3 stage.

CONCLUSIONS

Patients in N3 stage should at least have 30 lymph node examined. D2 lymph node dissection plus PAND may improve the overall survival for gastric cancer patients in N3 stage.

摘要

目的

阐明N3期胃癌D2淋巴结清扫术中进行腹主动脉旁淋巴结清扫的必要性。

方法

纳入2003年1月至2007年12月期间接受胃切除术的278例N3期胃癌患者。男性180例，女性98例，患者年龄26 - 93岁（中位数为61岁）。所有患者均接受了手术治疗。R0切除246例，R1切除32例。淋巴结清扫包括125例行D1淋巴结清扫，109例行D2淋巴结清扫，44例行D2 + 腹主动脉旁淋巴结清扫（PAND）。手术方式为全胃切除术（98例）和胃大部切除术（180例）。分析潜在的预后因素。

结果

N3期胃癌患者各站淋巴结转移率较高，34.1%的患者有腹主动脉旁淋巴结转移。Borrmann分型（HR = 1.350，95%CI：1.018 - 1.790，P = 0.037）、根治性（HR = 1.580，95%CI：1.076 - 2.322，P = 0.020）、浸润深度（HR = 1.697，95%CI：1.005 - 2.864，P = 0.048）、转移淋巴结比例（HR = 1.631，95%CI：1.261 - 2.111，P = 0.000）、结外转移（HR = 1.336，95%CI：1.027 - 1.738，P = 0.031）、术后辅助化疗（HR = 1.312，95%CI：1.015 - 1.696，P = 0.038）、淋巴结清扫范围（HR = 1.488和2.114，P = 0.054和0.000）以及获取淋巴结数量（HR = 1.503和2.112，P = 0.025和0.000）被发现是与总生存相关的因素。多因素分析中，仅Borrmann分型（HR = 1.399，95%CI：1.050 - 1.863，P = 0.022）、转移淋巴结比例（HR = 1.353，95%CI：1.016 - 1.802，P = 0.039）和淋巴结清扫范围（HR = 1.725，95%CI：1.111 - 2.678，P = 0.015）是N3期胃癌患者的独立预后因素。