Wu X-J, Miao R-L, Li Z-Y, Bu Z-D, Zhang L-H, Wu A-W, Zong X-L, Li S-X, Shan F, Ji X, Ren H, Ji J-F
Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China.
Eur J Surg Oncol. 2015 Jul;41(7):927-33. doi: 10.1016/j.ejso.2015.03.225. Epub 2015 Apr 3.
Gastric cancer is one of most common malignancies in the world. Currently the prognostic prediction is entirely based on the TNM staging system. In this study, we evaluated whether metastatic lymph node ratio (rN) at the time of surgery would improve the prognostic prediction in conjunction with the TNM staging system.
This retrospective study includes 745 patients, who had been referred for surgery due to gastric cancer between 1995 and 2007 and had at least 15 lymph nodes examined at the time of surgery without preoperative treatment. Clinicopathologic features and overall survival were analyzed using univariate and multivariate modes to identify the risk factors for overall survival.
Median overall survival of all patients analyzed is 57.8 months and 5-year overall survival is 49.5%. Tumor site, macroscopic type, pTNM stage, and rN stage are identified as independent prognostic factors. Increased positive lymph node ratio correlates with shorter survival in all patients and in each T and N stage. In stage III gastric cancer patients, rN stage shows additional prognostic value on overall survival (p < 0.001).
rN stage is a simple and promising prognostic factor of gastric cancer after surgery in addition to the TNM stage system especially in stage III patients. But the independent prognostic value of rN stage in stage I, II and IV gastric cancer is yet to be determined.
胃癌是世界上最常见的恶性肿瘤之一。目前，预后预测完全基于TNM分期系统。在本研究中，我们评估了手术时的转移淋巴结比率（rN）与TNM分期系统结合使用时是否能改善预后预测。
这项回顾性研究纳入了745例患者，这些患者在1995年至2007年间因胃癌接受手术治疗，且手术时至少检查了15个淋巴结，且未接受术前治疗。采用单因素和多因素分析方法分析临床病理特征和总生存期，以确定总生存期的危险因素。
所有分析患者的中位总生存期为57.8个月，5年总生存率为49.5%。肿瘤部位、大体类型、pTNM分期和rN分期被确定为独立的预后因素。在所有患者以及每个T和N分期中，阳性淋巴结比率增加与生存期缩短相关。在III期胃癌患者中，rN分期对总生存期具有额外的预后价值（p < 0.001）。
rN分期是胃癌手术后除TNM分期系统外一个简单且有前景的预后因素，尤其是在III期患者中。但rN分期在I、II和IV期胃癌中的独立预后价值尚待确定。
