Kawaguchi Tsutomu, Komatsu Shuhei, Ichikawa Daisuke, Kosuga Toshiyuki, Kubota Takeshi, Okamoto Kazuma, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Otsuji Eigo
Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Gastroenterol Hepatol. 2015 Nov;30(11):1603-9. doi: 10.1111/jgh.12986.
This study was designed to evaluate the clinical significance and prognostic impact of the total diameter of enlarged lymph nodes (TDL) on preoperative multidetector computed tomography (MDCT) in gastric cancer (GC).
Of a total of 480 GC patients between 2005 and 2009, 70 patients with a preoperative diagnosis of nodal metastasis on MDCT were included in this study. All regional lymph nodes showing metastatic involvement were preoperatively counted and measured.
The TDL was calculated, and using a receiver operating characteristic curve, a cutoff value of 45 mm in the two groups of large TDL (LTDL) and small TDL was found to be appropriate for TDL. No significant differences were observed in clinicopathological features, except for tumor recurrence, between the two groups. Univariate survival analysis revealed that patients with LTDL had a worse prognosis as well as an upper tumor location, deeper tumor depth, and further advanced pathological stage. Multivariable prognostic analysis identified LTDL as an independent worse prognostic factor (P = 0.0128).
GC patients with the total nodal diameter measuring 45 mm or more on MDCT have a worse prognosis. GC patients with the novel surrogate indicator of worse prognosis for a preoperative imaging diagnosis may have need of multimodal treatment to improve the survival.
本研究旨在评估胃癌（GC）患者术前多排螺旋计算机断层扫描（MDCT）中肿大淋巴结总直径（TDL）的临床意义及预后影响。
在2005年至2009年间的480例GC患者中，本研究纳入了70例术前MDCT诊断有淋巴结转移的患者。术前对所有显示有转移累及的区域淋巴结进行计数和测量。
计算了TDL，并通过绘制受试者工作特征曲线，发现大TDL（LTDL）组和小TDL组中TDL的截断值为45mm是合适的。除肿瘤复发外，两组间的临床病理特征未观察到显著差异。单因素生存分析显示，LTDL患者预后较差，且肿瘤位置较高、肿瘤深度较深、病理分期较晚。多变量预后分析确定LTDL是一个独立的不良预后因素（P = 0.0128）。
MDCT上总淋巴结直径测量为45mm或更大的GC患者预后较差。对于术前影像诊断为预后较差的新替代指标的GC患者，可能需要多模式治疗以提高生存率。
