在美国，更多的淋巴结清扫可提高淋巴结阴性的根治性胃癌患者的生存率。

Greater Lymph Node Retrieval Improves Survival in Node-Negative Resected Gastric Cancer in the United States.

作者信息

Mirkin Katelin A, Hollenbeak Christopher S, Wong Joyce

机构信息

Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.

Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.

出版信息

J Gastric Cancer. 2017 Dec;17(4):306-318. doi: 10.5230/jgc.2017.17.e35. Epub 2017 Nov 21.

PURPOSE

Guidelines in western countries recommend retrieving ≥15 lymph nodes (LNs) during gastric cancer resection. This study sought to determine whether the number of examined lymph nodes (eLNs), a proxy for lymphadenectomy, effects survival in node-negative disease.

MATERIALS AND METHODS

The US National Cancer Database (2003-2011) was reviewed for node-negative gastric adenocarcinoma. Treatment was categorized by neoadjuvant therapy (NAT) vs. initial resection, and further stratified by eLN. Kaplan-Meier and Weibull models were used to analyze overall survival.

RESULTS

Of the 1,036 patients who received NAT, 40.5% had ≤10 eLN, and most underwent proximal gastrectomy (67.8%). In multivariate analysis, greater eLN was associated with improved survival (eLN 16-20: HR, 0.71; P=0.039, eLN 21-30: HR, 0.55; P=0.001). Of the 2,795 patients who underwent initial surgery, 42.5% had ≤10 eLN, and the majority underwent proximal gastrectomy (57.2%). In multivariate analysis, greater eLN was associated with improved survival (eLN 11-15: HR, 0.81; P=0.021, eLN 16-20: HR, 0.73; P=0.004, eLN 21-30: HR, 0.62; P<0.001, and eLN >30: HR, 0.58; P<0.001).

CONCLUSIONS

In the United States, the majority of node-negative gastrectomies include suboptimal eLN. In node-negative gastric cancer, greater LN retrieval appears to have therapeutic and prognostic value, irrespective of initial treatment, suggesting a survival benefit to meticulous lymphadenectomy.

目的

西方国家的指南建议在胃癌切除术中清扫≥15枚淋巴结（LNs）。本研究旨在确定作为淋巴结清扫替代指标的送检淋巴结数量（eLNs）是否会影响淋巴结阴性疾病患者的生存。

材料与方法

对美国国家癌症数据库（2003 - 2011年）中淋巴结阴性的胃腺癌患者进行回顾性分析。治疗方式分为新辅助治疗（NAT）与初始切除术，并根据eLNs进一步分层。采用Kaplan - Meier法和Weibull模型分析总生存情况。

结果

在接受NAT的1036例患者中，40.5%的患者送检淋巴结≤10枚，且大多数接受近端胃切除术（67.8%）。多因素分析显示，更多的送检淋巴结与生存改善相关（送检淋巴结16 - 20枚：HR，0.71；P = 0.039；送检淋巴结21 - 30枚：HR，0.55；P = 0.001）。在接受初始手术的2795例患者中，42.5%的患者送检淋巴结≤10枚，且大多数接受近端胃切除术（57.2%）。多因素分析显示，更多的送检淋巴结与生存改善相关（送检淋巴结11 - 15枚：HR，0.81；P = 0.021；送检淋巴结16 - 20枚：HR，0.73；P = 0.004；送检淋巴结21 - 30枚：HR，0.62；P < 0.001；送检淋巴结>30枚：HR，0.58；P < 0.001）。