Wu Liangliang, Zhang Chen, Liang Yuexiang, Wang Xiaona, Ding Xuewei, Liang Han
Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Cancer for Cancer, Key Laboratory of Cancer Prevention and Therapy.
Department of Interventional Therapy, Tianjin Beichen Hospital, Tianjin.
Jpn J Clin Oncol. 2018 Apr 1;48(4):335-342. doi: 10.1093/jjco/hyy006.
D2 procedure has been accepted as the standard lymphadenectomy for advanced GC, while the role of No.14v lymph node (14v) dissection for distal GC is still controversial.
A total of 284 GC patients receiving D2 plus 14v dissection in our center were enrolled. Patients were categorized into two groups based on 14v status: positive group (PG) and negative group (NG). Clinicopathological factors correlated with 14v metastasis and prognostic variables were respectively analyzed.
Thirty-five patients (12.3%) had 14v metastasis. Metastasis to No.4d and No.6 lymph node were independent variables affecting 14v metastasis. Patients with positive 14v had a significant lower 3-year overall survival (OS) rate than those without (3-year OS: 42.9% vs. 70.3%, P < 0.001). Multivariable analysis demonstrated that 14v status was an independent prognostic factor for III stage GC (hazard ratio 1.462, 95% confident interval: 1.182-2.309, P = 0.027). The prognosis of 14v positive patients correlated with tumor size and No.6 lymph node status in univariate analysis.
GC patients with No.4d and No.6 lymph node metastasis were more likely to have positive 14v. Status of 14v was an independent prognostic factor for III stage GC. Patients with 14v metastasis usually had a poorer prognosis, while survival in such patients after curative surgery was similar to that of patients staged IIIc without 14v metastasis.
D2手术已被公认为进展期胃癌的标准淋巴结清扫术，而对于远端胃癌，第14v组淋巴结（14v）清扫的作用仍存在争议。
本中心共纳入284例行D2加14v清扫的胃癌患者。根据14v状态将患者分为两组：阳性组（PG）和阴性组（NG）。分别分析与14v转移相关的临床病理因素和预后变量。
35例患者（12.3%）出现14v转移。第4d组和第6组淋巴结转移是影响14v转移的独立变量。14v阳性患者的3年总生存率显著低于14v阴性患者（3年总生存率：42.9%对70.3%，P<0.001）。多变量分析表明，14v状态是Ⅲ期胃癌的独立预后因素（风险比1.462，95%置信区间：1.182 - 2.309，P = 0.027）。单变量分析中，14v阳性患者的预后与肿瘤大小和第6组淋巴结状态相关。
第4d组和第6组淋巴结转移的胃癌患者更有可能出现14v阳性。14v状态是Ⅲ期胃癌的独立预后因素。14v转移患者的预后通常较差，而此类患者根治性手术后的生存率与无14v转移的Ⅲc期患者相似。
