根治性胃切除术后胃腺癌患者转移淋巴结比率的预后意义

Prognostic significance of metastatic lymph nodes ratio in patients with gastric adenocarcinoma after curative gastrectomy.

作者信息

Zhang Meiling, Wang Jian, Shi Wei, Chen Wenjiao, Li Wei, Shu Yongqian, Liu Ping, Lu Kaihua

机构信息

Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.

Cancer Center of Nanjing Medical University, Nanjing, Jiangsu 210029, China. Email:

出版信息

Chin Med J (Engl). 2014;127(10):1874-8.

PMID:24824248

Abstract

BACKGROUND

We evaluated the impact of the number of metastatic lymph nodes and the metastatic lymph nodes ratio (the ratio between metastatic lymph nodes and total dissected lymph nodes, MLNR) in patients with gastric adenocarcinoma following curative gastrectomy and also analyzed the relationship between the number of removed lymph nodes and prognosis in node-negative gastric cancer.

METHODS

From January 2005 to December 2010, 1 390 patients who were diagnosed with gastric adenocarcinoma and underwent curative gastrectomy were included. In particular, lymph node metastasis was not present in 515 patients. The number of metastatic lymph nodes and the metastatic lymph nodes ratio were selected for univariate and multivariate analyses to evaluate their influences on the disease outcome. The survival curve was presented according to the number of removed lymph nodes in node-negative gastric cancer using Kaplan-Meier plots.

RESULTS

The overall 5-year survival rate was 54% in this group. Univariate analysis revealed that age category, macroscopic appearance, histological grade, tumor size, depth of primary tumor invasion, number of metastatic lymph nodes, metastatic lymph nodes ratio, tumor, nodes, metastasis-classification (TNM) stage and status of lymphovascular, and vessel invasion have significant impact on survival. The number of metastatic lymph nodes and the metastatic lymph nodes ratio both have significant impact on survival (P < 0.001). However, in multivariate analyses, only the metastatic lymph nodes ratio was identified to be an independent prognostic factor (P < 0.001). The number of removed lymph nodes in node-negative was a strong prognostic factor of survival, the more lymph nodes dissected, the better the survival.

CONCLUSIONS

The metastatic lymph nodes ratio has more significant prognostic value for survival in patients with gastric cancer following curative gastrectomy than the number of metastatic lymph nodes. The number of removed lymph nodes might be an important prognostic factor for gastric cancer without lymph node metastasis.

摘要

背景

我们评估了根治性胃切除术后胃腺癌患者的转移淋巴结数量和转移淋巴结比率（转移淋巴结与切除的总淋巴结数量之比，即MLNR）的影响，并分析了淋巴结阴性胃癌患者切除淋巴结数量与预后的关系。

方法

纳入2005年1月至2010年12月期间诊断为胃腺癌并接受根治性胃切除术的1390例患者。其中，515例患者无淋巴结转移。选择转移淋巴结数量和转移淋巴结比率进行单因素和多因素分析，以评估它们对疾病结局的影响。使用Kaplan-Meier曲线根据淋巴结阴性胃癌患者切除的淋巴结数量绘制生存曲线。

结果

该组患者的总体5年生存率为54%。单因素分析显示，年龄类别、大体外观、组织学分级、肿瘤大小、原发肿瘤浸润深度、转移淋巴结数量、转移淋巴结比率、肿瘤-淋巴结-转移分期（TNM分期）以及淋巴管和血管侵犯状态对生存有显著影响。转移淋巴结数量和转移淋巴结比率均对生存有显著影响（P < 0.001）。然而，在多因素分析中，仅转移淋巴结比率被确定为独立的预后因素（P < 0.001）。淋巴结阴性患者切除的淋巴结数量是生存的有力预后因素，切除的淋巴结越多，生存越好。