Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea.
Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
BMC Cancer. 2019 Jul 22;19(1):719. doi: 10.1186/s12885-019-5922-8.
Recently, the incidence of gastroesophageal junction (GEJ) cancer has been increasing in Eastern countries. Mediastinal lymph node (MLN) metastasis rates among patients with GEJ cancer are reported to be 5-25%. However, survival benefits associated with MLN dissection in GEJ cancer has been a controversial issue, especially in Eastern countries, due to its rarity and potential morbidity.
We retrospectively reviewed 290 patients who underwent surgery for GEJ cancer at the National Cancer Center in Korea from June 2001 to December 2015. Clinicopathologic characteristics and surgical outcomes were compared between patients without MLN dissection (Group A) and patients with MLN dissection (Group B). Prognostic factors associated with the survival rate were identified in a multivariate analysis.
Twenty-nine (10%) patients underwent MLN dissection (Group B). Three of 29 patients (10.3%) showed a metastatic MLN in Group B. For abdominal LNs, the 5-year disease-free survival rate was 79.5% in Group A and 33.9% in Group B (P < 0.001). The multivariate analysis revealed that abdominal LN dissection, pT category, and pN category were statistically significant prognostic factors. LNs were the most common site for recurrence in both groups.
Abdominal LN dissection and pathologic stage are the important prognostic factors for type II and III GEJ cancer rather than mediastinal lymph node dissection.
最近，东方国家胃食管结合部（GEJ）癌症的发病率一直在上升。据报道，GEJ 癌症患者纵隔淋巴结（MLN）转移率为 5-25%。然而，由于其罕见性和潜在的发病率，MLN 解剖术在 GEJ 癌症中的生存获益一直是一个有争议的问题，尤其是在东方国家。
我们回顾性分析了 2001 年 6 月至 2015 年 12 月在韩国国家癌症中心接受 GEJ 癌症手术的 290 名患者。比较了未行 MLN 解剖术（A 组）和行 MLN 解剖术（B 组）患者的临床病理特征和手术结果。采用多因素分析确定与生存率相关的预后因素。
29 名（10%）患者行 MLN 解剖术（B 组）。B 组中有 3 例（10.3%）患者的 MLN 转移。对于腹部淋巴结，A 组的 5 年无病生存率为 79.5%，B 组为 33.9%（P<0.001）。多因素分析显示，腹部淋巴结清扫术、pT 分期和 pN 分期是统计学上的预后因素。淋巴结是两组患者中最常见的复发部位。
腹部淋巴结清扫术和病理分期是 II 型和 III 型 GEJ 癌症的重要预后因素，而不是纵隔淋巴结清扫术。
