Komatsu Shuhei, Ichikawa Daisuke, Miyamae Mahito, Kosuga Toshiyuki, Okamoto Kazuma, Arita Tomohiro, Konishi Hirotaka, Morimura Ryo, Murayama Yasutoshi, Shiozaki Atsushi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
J Gastrointest Surg. 2016 Sep;20(9):1565-71. doi: 10.1007/s11605-016-3197-9. Epub 2016 Jun 28.
Nodal metastasis is an important clinical issue in gastric cancer patients. This study was designed to investigate the clinical usefulness of the positive lymph node ratio (PLNR), which reflects both metastatic and retrieved lymph node numbers, in patients with pN3 gastric cancer.
We retrospectively analyzed the records of 138 consecutive pN3 patients who underwent curative gastrectomy with lymphadenectomy from 2000 to 2012.
A PLNR of 0.4 was proved to be the best cutoff value to stratify the prognosis of patients with pN3 gastric cancer (P < 0.001). Univariate and multivariate analyses revealed that older age, larger tumor size (≥10 cm), and PLNR ≥ 0.4 [P < 0.001, HR 3.1 (95 % CI 1.7-5.4)] were independent prognostic factors in pN3 gastric cancer. Regarding the recurrence, patients with PLNR <0.4 had a significantly lower rate of lymph node recurrence than those with PLNR ≥0.4 (P = 0.020). There was no significant difference in the lymph node recurrence rate between N3a and N3b patients in the PLNR <0.4 group [P = 0.546, 11.6 % (7/60) vs. 12.5 (1/8)], indicating a better local control regardless of pN3 subgroups.
PLNR is useful to stratify the prognosis and evaluate the extent of local tumor clearance in pN3 gastric cancer.
淋巴结转移是胃癌患者的一个重要临床问题。本研究旨在探讨阳性淋巴结比率（PLNR）在pN3期胃癌患者中的临床应用价值，该比率反映了转移淋巴结数和检出淋巴结数。
我们回顾性分析了2000年至2012年间138例连续接受根治性胃切除术及淋巴结清扫术的pN3期患者的记录。
PLNR为0.4被证明是对pN3期胃癌患者预后进行分层的最佳临界值（P < 0.001）。单因素和多因素分析显示，年龄较大、肿瘤较大（≥10 cm）以及PLNR≥0.4 [P < 0.001，HR 3.1（95%CI 1.7 - 5.4）]是pN3期胃癌的独立预后因素。关于复发情况，PLNR<0.4的患者淋巴结复发率明显低于PLNR≥0.4的患者（P = 0.020）。在PLNR<0.4组中，N3a和N3b患者的淋巴结复发率无显著差异[P = 0.546，11.6%（7/60）对12.5%（1/8）]，表明无论pN3亚组如何，局部控制效果更好。
PLNR有助于对pN3期胃癌患者的预后进行分层，并评估局部肿瘤清除程度。
