Ma Min, Chen Shi, Zhu Bao-yan, Zhao Bai-Wei, Wang Hua-She, Xiang Jun, Wu Xiao-Bin, Lin Yi-Jia, Zhou Zhi-Wei, Peng Jun-Sheng, Chen Ying-Bo
The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastric & pancreatic Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, China.
The State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China; Department of Gastroenterology Surgery, The 6th Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
PLoS One. 2015 Jan 29;10(1):e0114939. doi: 10.1371/journal.pone.0114939. eCollection 2015.
To assess the clinical significance and risk factors of solitary lymph node metastasis (SLM) in gastric carcinoma and establish a more accurate method to evaluate the possibility of lymph node metastasis (LM).
A total of 385 patients with gastric carcinoma who underwent D2 lymphadenectomy at the Cancer Center of Sun Yat-Sen University were included in this research. Then we used a group of data from Sun Yat-sen University Gastrointestinal Hospital (SYSUGIH) to validate the accuracy of our developed method. The χ2 test, Kaplan-Meier analysis, log-rank test, COX model, and discriminate analysis were used to analyze the data with SPSS13.0.
We found that the LM number and pathological T staging were independent prognostic risk factors. CEA grading, LN status by CT, and T staging by CT were independent risk factors for LM in gastric carcinoma. In addition, we developed the equation Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1 = CEA grading, X3 = LN status by CT, X4 = T staging by CT) to evaluate the situation of LM. The data from SYSUGIH shows this equation has a better accuracy compared with CT.
SLM is an independent risk factor in gastric cancer. And there was no survival difference between the skip metastasis group and the other SLM group (P = 0.659). It is inappropriate for the patient with SLM doing a standard D2 lymphadenectomy, due to the fact that LM rarely occurs in the splenic artery, splenic hilum. The risk factors for LM include CEA grading, LN status by CT, and T staging by CT. And we can use Y = -5.0 + X1 + 1.8X3 + 0.7X4 (X1, CEA grading, X3 = LN status by CT, X4 = T staging by CT, the critical value is 0.3) to estimate the possibility of LM, which has a better accuracy compared with CT.
评估胃癌中孤立淋巴结转移（SLM）的临床意义及危险因素，并建立一种更准确的方法来评估淋巴结转移（LM）的可能性。
本研究纳入了中山大学肿瘤防治中心385例行D2淋巴结清扫术的胃癌患者。然后我们使用中山大学附属胃肠外科医院（SYSUGIH）的一组数据来验证我们所建立方法的准确性。采用χ2检验、Kaplan-Meier分析、对数秩检验、COX模型和判别分析，运用SPSS13.0对数据进行分析。
我们发现LM数量和病理T分期是独立的预后危险因素。癌胚抗原（CEA）分级、CT检查的淋巴结状态以及CT检查的T分期是胃癌LM的独立危险因素。此外，我们建立了方程Y = -5.0 + X1 + 1.8X3 + 0.7X4（X1 = CEA分级，X3 = CT检查的淋巴结状态，X4 = CT检查的T分期）来评估LM情况。SYSUGIH的数据表明，与CT相比，该方程具有更高的准确性。
SLM是胃癌的独立危险因素。跳跃转移组与其他SLM组之间无生存差异（P = 0.659）。对于SLM患者行标准D2淋巴结清扫术并不合适，因为LM很少发生于脾动脉、脾门。LM的危险因素包括CEA分级、CT检查的淋巴结状态以及CT检查的T分期。我们可以使用Y = -5.0 + X1 + 1.8X3 + 0.7X4（X1 = CEA分级，X3 = CT检查的淋巴结状态，X4 = CT检查得T分期，临界值为0.3）来估计LM的可能性，与CT相比，其准确性更高。
