Chen Yinbo, Li Cong, Du Yian, Xu Qi, Ying Jieer, Luo Cong
Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China.
Department of Lymphoma Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China.
Oncotarget. 2017 Aug 7;8(41):70841-70846. doi: 10.18632/oncotarget.19998. eCollection 2017 Sep 19.
This study is to evaluate the prognostic and predictive value of metastatic lymph node ratio (MLR) in stage III gastric cancer following radical D2 dissection.
87 patients who underwent radical resection with D2 lymphadenectomy were retrospectively evaluated. The median age was 60 with a 2:1 ratio of male/female. Of these 87 patients, 83 underwent total gastrectomy, the remaining 4 underwent subtotal gastrectomy and 57 patients received adjuvant chemotherapy with fluoropyrimidines. Indexes of lymph node involvement and other clinicopathological data were analyzed. Survival was determined by the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox proportional hazards model.
Median total retrieved lymph node number was 35 (range: 10-104) with median metastatic lymph node amount of eight (range: 0-71). Median survival time was 31.7 months with a 3-year survival rate of 36.4%. Patients were divided into four groups according to MLR: MLR0, 0; MLR1, <0.1; MLR2, 0.1-0.25; MLR3, >0.25. After median follow-up of 31 months, median OS rates of MLR0 to MLR3 were 37.1m, 35.9m, 31.5m and 20.8m, respectively (p=0.013). Median OS rates were significantly different among subgroups: 39.3m and 36.5m were obtained for low subgroups (MLR<0.24) with or without adjuvant chemotherapy, respectively; 22.9m and 12.2m were found in high subgroups (MLR>0.24) with and without chemotherapy, respectively (p=0.002). Finally, MLR constituted an independent prognostic factor in multivariable analysis.
After R0 resection with D2 lymphadenectomy for stage III gastric cancer, MLR constitutes an effective prognostic indicator. Patients with high MLR may benefit the most from adjuvant chemotherapy.
本研究旨在评估根治性D2清扫术后Ⅲ期胃癌患者的转移淋巴结比率（MLR）的预后及预测价值。
回顾性评估87例行D2淋巴结清扫根治性切除术的患者。中位年龄为60岁，男女比例为2:1。这87例患者中，83例行全胃切除术，其余4例行次全胃切除术，57例患者接受氟嘧啶类辅助化疗。分析淋巴结受累指标及其他临床病理数据。采用Kaplan-Meier法和对数秩检验确定生存率。使用Cox比例风险模型进行多因素分析。
中位总检出淋巴结数为35个（范围：10 - 104个），中位转移淋巴结数为8个（范围：0 - 71个）。中位生存时间为31.7个月，3年生存率为36.4%。根据MLR将患者分为四组：MLR0，0；MLR1，<0.1；MLR2，0.1 - 0.25；MLR3，>0.25。中位随访31个月后，MLR0至MLR3组的中位总生存期分别为37.1个月、35.9个月、31.5个月和20.8个月（p = 0.013）。各亚组中位总生存期有显著差异：低亚组（MLR<0.24）接受或未接受辅助化疗的中位总生存期分别为39.3个月和36.5个月；高亚组（MLR>0.24）接受和未接受化疗的中位总生存期分别为22.9个月和12.2个月（p = 0.002）。最后，MLR在多变量分析中构成独立的预后因素。
Ⅲ期胃癌行D2淋巴结清扫R0切除术后，MLR是有效的预后指标。MLR高的患者可能从辅助化疗中获益最大。
