Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, 104-0045, Tokyo, Japan.
Gastric Cancer. 2019 Sep;22(5):1029-1035. doi: 10.1007/s10120-019-00938-8. Epub 2019 Feb 18.
It remains unclear whether total gastrectomy is necessary for patients with proximal T2/T3 gastric cancer. To explore the oncological safety of proximal gastrectomy for proximal T2/T3 gastric cancer, in this study, we evaluated the metastatic rates in and the therapeutic effect of dissection of key distal lymph node stations that are usually excluded in proximal gastrectomy.
In this study, we examined 202 patients seen between January 2000 and December 2012, who underwent total gastrectomy with lymph node dissection (D1/D1+/D2; 2/17/183) and was pathologically diagnosed as T2/T3 gastric cancer exclusively located in the upper third of the stomach. The theoretical therapeutic necessity of dissecting lymph nodes at each lymph node station was evaluated based on the therapeutic index calculated by multiplying the frequency of metastasis at each station and the 5-year survival rate of patients with metastasis to that station.
The 5-year overall survival rate (95% confidence interval) was 72.9% (65.5-80.3). The metastatic rates at #4d and #12a were very low (0.99% and 0.006%, respectively), and those at #5 and #6 were zero, and therapeutic indices for #4d, #5, #6 and #12a were zero. On the other hand, the most frequent metastatic station was #3, followed by #1, #2 and #7 (overall metastatic rate > 12%), which was consistent with the order of the therapeutic indices.
Considering the nodal stations that need to be dissected, proximal gastrectomy would be the choice and oncologically safe for patients with T2/T3 proximal gastric cancer.
对于近端 T2/T3 胃癌患者，是否需要全胃切除术仍不清楚。为了探讨近端胃切除术治疗近端 T2/T3 胃癌的肿瘤安全性，本研究评估了通常在近端胃切除术中被排除的关键远端淋巴结站的转移率和治疗效果。
本研究共纳入 202 例 2000 年 1 月至 2012 年 12 月期间接受全胃切除术和淋巴结清扫术（D1/D1+/D2；2/17/183）且病理诊断为仅位于胃上部三分之一的 T2/T3 胃癌的患者。基于每个淋巴结站的转移频率和转移到该站的患者 5 年生存率相乘得到的治疗指数，评估了在每个淋巴结站解剖淋巴结的理论治疗必要性。
患者的 5 年总生存率（95%置信区间）为 72.9%（65.5-80.3）。#4d 和 #12a 的转移率非常低（分别为 0.99%和 0.006%），#5 和 #6 为零，#4d、#5、#6 和 #12a 的治疗指数为零。另一方面，最常见的转移站是#3，其次是#1、#2 和 #7（总转移率>12%），这与治疗指数的顺序一致。
考虑到需要解剖的淋巴结站，近端胃切除术是 T2/T3 近端胃癌患者的首选术式，且具有肿瘤学安全性。
