Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT17.6010, Houston, TX, 77030, USA.
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Gastrointest Surg. 2018 Aug;22(8):1325-1333. doi: 10.1007/s11605-018-3764-3. Epub 2018 Apr 20.
It is unclear how preoperative therapy for gastric cancer affects the metastasis rate of lymph nodes (LNs) and whether the location of positive LNs affects survival after preoperative therapy. Therefore, we determined the association between positive central lymph nodes (CnLNs) and disease stage and overall survival (OS).
We reviewed a prospectively maintained database to identify patients who had undergone resection of gastric adenocarcinoma at our institution from 2005 to 2015. CnLNs were defined as common hepatic, celiac, and proximal splenic artery LNs (stations no. 8, 9, and 11p). The frequency of CnLN metastases and risk factors affecting OS were examined.
We identified 356 patients. Preoperative therapy was administered to 66% of patients. D2 LN dissection was performed in 80% of patients, and the median number of LNs examined was 25 (IQR, 18-34). In 243 patients (68%), CnLNs had undergone separate pathologic examination; the CnLN-positive rate was 9.1% (22 of 243; station no. 8, 4.5%; no. 9, 2.1%; and no. 11p, 4.8%). CnLN metastasis was associated with shorter 3-year OS in patients with pN2/3 disease (33 vs. 62%; p = 0.004). Among patients who had undergone preoperative therapy, ypT3-4 stage (HR 2.44; p = 0.01) and positive CnLNs (HR 5.44; p < 0.001) were negatively associated with OS by multivariate analysis.
CnLN metastases are uncommon in gastric cancer and have an adverse effect on OS in patients who have undergone preoperative therapy. Larger multi-institutional studies are needed to determine whether CnLN positivity requires a separate staging category after preoperative therapy.
术前治疗胃癌会如何影响淋巴结（LNs）转移率，以及阳性 LNs 的位置是否会影响术前治疗后的生存，目前仍不清楚。因此，我们确定了阳性中央淋巴结（CnLNs）与疾病分期和总生存（OS）之间的关系。
我们回顾性地分析了 2005 年至 2015 年在我院接受胃腺癌切除术的患者的前瞻性数据库，以确定患者。CnLNs 被定义为肝总动脉、腹腔动脉和脾动脉近端淋巴结（站号 8、9 和 11p）。我们检查了 CnLN 转移的频率和影响 OS 的危险因素。
我们确定了 356 名患者。66%的患者接受了术前治疗。80%的患者接受了 D2 淋巴结清扫术，检查的淋巴结中位数为 25（IQR，18-34）。在 243 名（68%）患者中，CnLN 分别进行了病理检查；CnLN 阳性率为 9.1%（22/243；站号 8，4.5%；9 号，2.1%；11p 号，4.8%）。CnLN 转移与 pN2/3 疾病患者 3 年 OS 缩短相关（33%比 62%；p=0.004）。在接受术前治疗的患者中，ypT3-4 期（HR 2.44；p=0.01）和 CnLN 阳性（HR 5.44；p<0.001）与 OS 呈负相关。
CnLN 转移在胃癌中并不常见，并且对接受术前治疗的患者的 OS 有不利影响。需要更大规模的多机构研究来确定术前治疗后 CnLN 阳性是否需要单独的分期类别。
