Lee Chang Min, Cho Jun-Min, Jang You-Jin, Park Sung-Soo, Park Seong-Heum, Kim Seung-Joo, Mok Young-Jae, Kim Chong-Suk, Kim Jong-Han
Department of Gastroenterologic Surgery, Korea University Medical Center, Seoul, South Korea.
Ann Surg Oncol. 2015 Mar;22(3):765-71. doi: 10.1245/s10434-014-4073-z. Epub 2014 Sep 9.
In TNM staging system, lymph node staging is based on the number of metastatic lymph nodes in gastric cancer and micrometastasis is not considered. Several reports proposed the importance of lymph node micrometastasis as the causative factor for recurrence and poor survival, but it remains controversial among researchers.
A total of 482 gastric cancer patients who underwent curative resection from 2004 to 2010 at Korea University Medical Center Ansan Hospital, South Korea were prospectively enrolled. For detecting lymph node micrometastasis, immunohistochemical staining with anti-cytokeratin antibody (CAM 5.2) was performed on negative lymph nodes by hematoxylin-eosin (H-E) staining. Survival differences were compared between conventional node staging and new node staging that took micrometastasis into consideration. Also, the prognostic value of lymph node micrometastasis was investigated in multivariate analysis.
A total of 156 patients (32.4%) showed lymph node micrometastasis. Overall, the micrometastatic group had more advanced tumor and lymph node stage, lymphovascular cancer cell invasion, a higher rate of recurrence, and poor survival. Furthermore, when the cumulative numbers of macro- and micrometastatic lymph nodes were calculated together, the discriminative power of survival difference between each node stage became more stratified. Also, multivariate analysis using Cox's proportional hazards model demonstrated perineural invasion, pathologic T stage, dissected lymph nodes, macro- and micrometastatic lymph nodes are independent prognostic factors.
Lymph node micrometastasis was clinically significant as a risk factor for recurrent gastric cancer. Lymph node micrometastasis should be considered when estimating TNM stage for determining prognosis and the best treatment strategy.
在TNM分期系统中，胃癌的淋巴结分期基于转移淋巴结的数量，未考虑微转移情况。有几份报告提出淋巴结微转移作为复发和生存不良的致病因素的重要性，但在研究人员中仍存在争议。
前瞻性纳入了2004年至2010年在韩国延世大学医科大学安山医院接受根治性切除的482例胃癌患者。为检测淋巴结微转移，对苏木精-伊红（H-E）染色阴性的淋巴结进行抗细胞角蛋白抗体（CAM 5.2）免疫组化染色。比较了传统淋巴结分期和考虑微转移的新淋巴结分期之间的生存差异。此外，在多变量分析中研究了淋巴结微转移的预后价值。
共有156例患者（32.4%）出现淋巴结微转移。总体而言，微转移组的肿瘤和淋巴结分期更晚，存在淋巴管癌细胞浸润，复发率更高，生存率较差。此外，当将宏观和微观转移淋巴结的累积数量一起计算时，各淋巴结分期之间生存差异的判别能力变得更加分层。使用Cox比例风险模型的多变量分析表明，神经周围浸润、病理T分期、清扫淋巴结数量、宏观和微观转移淋巴结是独立的预后因素。
淋巴结微转移作为复发性胃癌的危险因素具有临床意义。在评估TNM分期以确定预后和最佳治疗策略时，应考虑淋巴结微转移情况。
