Chen Jian-Hui, Cai Shi-Rong, Zhai Er-Tao, Chen Si-Le, Wu Kai-Ming, Song Wu, He Yu-Long
Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Gastric Cancer Center, Sun Yat-sen University Guangzhou 510080, China.
Int J Clin Exp Pathol. 2015 Nov 1;8(11):14365-73. eCollection 2015.
The Japanese Gastric Cancer Treatment Guidelines (third edition) have assigned No. 7 station left gastric artery lymph nodes (LNs) to the D1 range of lymphatic dissection. We investigated the clinicopathological characteristics, survival impact, and appropriateness of ascribing No. 7 station LNs to D1 lymphadenectomy in gastric cancer. Patients (n=608) undergoing radical resection with No. 7 station LN dissection were recruited between January 1997 and June 2008. They were subdivided into four groups: N0, no LN metastasis; D1, LN without No. 7 station LN metastasis in the D1 lymphadenectomy region; No. 7, No. 7 station LN without LN metastasis in the D2 lymphadenectomy region; and D2, LN without No. 7 station LN metastasis in the D2 lymphadenectomy region. Of these, 17.2% (n=105) were positive for No. 7 LN metastasis, an important, independent prognostic factor associated with poor clinicopathological parameters, advanced tumor stage, and reduced survival. Tumor behavior in the No. 7 group was similar to that in the D2 group, but poorer than in the D1 group in terms of advanced tumor stage, with 5-year survival rates of 34.3%, 25.9% and 54.6%, respectively. Five-year survival rates in the No. 7 group were comparable to those in the D2 group (P>0.05), but significantly lower than in the D1 group (P<0.05). Logistic multivariate regression analysis established No. 3 and 9 station LN metastasis, node classification, and tumor-node-metastasis stage as independent risk factors for No. 7 station LN metastasis. Thus, No. 7 station LNs should be ascribed to D2 lymphadenectomy in gastric cancer.
《日本胃癌治疗指南（第三版）》已将第7站胃左动脉淋巴结（LNs）纳入D1淋巴结清扫范围。我们研究了胃癌中第7站LNs纳入D1淋巴结清扫术的临床病理特征、生存影响及合理性。1997年1月至2008年6月期间招募了608例行第7站LN清扫根治性切除术的患者。他们被分为四组：N0，无LN转移；D1，D1淋巴结清扫区域内无第7站LN转移的LN；第7组，D2淋巴结清扫区域内无LN转移的第7站LN；D2，D2淋巴结清扫区域内无第7站LN转移的LN。其中，17.2%（n = 105）第7站LN转移呈阳性，这是一个与不良临床病理参数、肿瘤晚期及生存率降低相关的重要独立预后因素。第7组的肿瘤行为与D2组相似，但在肿瘤晚期方面比D1组差，5年生存率分别为34.3%、25.9%和54.6%。第7组的5年生存率与D2组相当（P>0.05），但显著低于D1组（P<0.05）。Logistic多因素回归分析确定第3和9站LN转移、淋巴结分类及肿瘤-淋巴结-转移分期为第7站LN转移的独立危险因素。因此，胃癌中第7站LNs应纳入D2淋巴结清扫术。
