Jiao Xu-Guang, Deng Jing-Yu, Zhang Ru-Peng, Wu Liang-Liang, Wang Li, Liu Hong-Gen, Hao Xi-Shan, Liang Han
Xu-Guang Jiao, Jing-Yu Deng, Ru-Peng Zhang, Liang-Liang Wu, Li Wang, Hong-Gen Liu, Xi-Shan Hao, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China.
World J Gastroenterol. 2014 Apr 7;20(13):3640-8. doi: 10.3748/wjg.v20.i13.3640.
To elucidate the potential impact of examined lymph nodes (eLNs) on long-term survival of node-negative gastric cancer patients after curative surgery.
A total of 497 node-negative gastric cancer patients who underwent curative gastrectomy between January 2000 and December 2008 in our center were enrolled in this study. Patients were divided into 4 groups according to eLNs through cut-point analysis. Clinicopathological features were compared between ≤ 15 eLNs group and > 15 eLNs group and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified using the Cox proportional hazards regression model. Stratified analysis was performed to investigate the impact of eLNs on patient survival in each stage. Overall survival was also compared among the four groups. Finally, we explored the recurrent sites associated with eLNs.
Patients with eLNs > 15 had a better survival compared with those with eLNs ≤ 15 for the entire cohort. By the multivariate survival analysis, we found that the depth of invasion and the number of eLNs were the independent predictors of overall survival (OS) of patients with node-negative gastric cancer. According to the cut-point analysis, T2-T4 patients with 11-15 eLNs had a significantly longer mean OS than those with 4-10 eLNs or 1-3 eLNs. Patients with ≤ 15 eLNs were more likely to experience locoregional and peritoneal recurrence than those with > 15 eLNs.
Number of eLNs could predict the prognosis of node-negative gastric cancer, and dissection of > 15 eLNs is recommended during lymphadenectomy so as to improve the long-term survival.
阐明经检查的淋巴结（eLNs）对根治性手术后淋巴结阴性胃癌患者长期生存的潜在影响。
本研究纳入了2000年1月至2008年12月在本中心接受根治性胃切除术的497例淋巴结阴性胃癌患者。通过切点分析，根据eLNs将患者分为4组。比较≤15个eLNs组和>15个eLNs组的临床病理特征，并分析潜在的预后因素。采用Log-rank检验评估组间的统计学差异。使用Cox比例风险回归模型确定独立预后因素。进行分层分析以研究eLNs对各阶段患者生存的影响。还比较了四组的总生存期。最后，我们探索了与eLNs相关的复发部位。
对于整个队列，eLNs>15的患者比eLNs≤15的患者生存更好。通过多因素生存分析，我们发现浸润深度和eLNs数量是淋巴结阴性胃癌患者总生存期（OS）的独立预测因素。根据切点分析，T2-T4期有11-15个eLNs的患者平均OS明显长于有4-10个eLNs或1-3个eLNs的患者。eLNs≤15的患者比eLNs>15的患者更易发生局部区域和腹膜复发。
eLNs数量可预测淋巴结阴性胃癌的预后，建议在淋巴结清扫术中清扫>15个eLNs以提高长期生存率。
