Biondi A, D'Ugo D, Cananzi F C M, Papa V, Borasi A, Sicoli F, Degiuli M, Doglietto G, Persiani R
General Surgery Unit, Department of Surgery, "A. Gemelli" University Hospital, Catholic University of Rome, Largo A. Gemelli 8, Rome 00167, Italy.
Surgical Oncology Unit - Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089, MI, Italy.
Eur J Surg Oncol. 2015 Jun;41(6):779-86. doi: 10.1016/j.ejso.2015.03.227. Epub 2015 Apr 8.
According to the TNM classification, the analysis of 16 or more lymph nodes is required for the appropriate staging of gastric cancer. The aim of this study was to evaluate whether this number of resected lymph nodes also affects survival.
This was a multicenter retrospective study based on an analysis of 992 patients with gastric adenocarcinoma who underwent curative resection between January 1980 and December 2009. Patients were classified according to the number of resected lymph nodes (<16 and ≥16 lymph nodes), the anatomical extent of lymph node dissection (D2 vs. D1), and the staging criteria of the seventh edition of the UICC/AJCC TNM staging system. Survival estimates were determined by univariate and multivariate analyses.
Based on the univariate and multivariate analyses, the resection of 16 or more lymph nodes was associated with significantly better survival [p = 0.002; hazard ratio (HR) (95% confidence interval [CI]): 0.519 (0.345-0.780)]. Patients with a lymph node count <16 had a significantly worse survival rate than patients with a lymph node count ≥16 in the pN0 (p = 0.001), pN1 (p = 0.007) and pN2 (p = 0.001) stages. In the majority of cases, ≥16 lymph nodes were retrieved when D2 dissection was performed.
In gastric cancer the retrieval of less than 16 lymph nodes may cause inaccurate staging and/or inadequate treatment, thus affecting survival rates. These patients should be considered a high-risk group for stage migration and worse survival compared with those who have a retrieval of more than 16 lymph nodes.
根据TNM分类，胃癌的准确分期需要分析16个或更多淋巴结。本研究的目的是评估切除的淋巴结数量是否也会影响生存率。
这是一项多中心回顾性研究，基于对1980年1月至2009年12月期间接受根治性切除的992例胃腺癌患者的分析。根据切除的淋巴结数量（<16个和≥16个淋巴结）、淋巴结清扫的解剖范围（D2与D1）以及UICC/AJCC TNM分期系统第七版的分期标准对患者进行分类。通过单因素和多因素分析确定生存估计值。
基于单因素和多因素分析，切除16个或更多淋巴结与显著更好的生存率相关[p = 0.002；风险比（HR）（95%置信区间[CI]）：0.519（0.345 - 0.780）]。在pN0（p = 0.001）、pN1（p = 0.007）和pN2（p = 0.001）期，淋巴结计数<16的患者的生存率明显低于淋巴结计数≥16的患者。在大多数情况下，进行D2清扫时可获取≥16个淋巴结。
在胃癌中，获取少于16个淋巴结可能导致分期不准确和/或治疗不充分，从而影响生存率。与获取超过16个淋巴结的患者相比，这些患者应被视为分期迁移和生存较差的高危人群。
