Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China.
Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
J Cancer Res Clin Oncol. 2020 Feb;146(2):515-528. doi: 10.1007/s00432-019-03081-0. Epub 2019 Dec 7.
The present study aims to validate possible stage migration of lymph node metastasis related to the insufficient examined lymph node (ELN) count in pN3a gastric cancer (GC) patients.
1976 pN3 patients who underwent the R0 surgery in three high-capacity institutions in China were enrolled to explore the stage migration of nodal involvement, and 3146 pN3 cases from the Surveillance, Epidemiology, and End Results (SEER) Program Registry were used as an external validation cohort.
After the propensity score matching of the Chinese cohort, the ELN count, as an independent predictor for GC outcome, was confirmed to be associated with the stage migration of lymph node metastasis in pN3a patients based on the univariate and multivariate survival analyses. Logistic regress was adopted to elucidate that the ELN count was an independent factor related to the long-term survival status of GC patients after curative surgery. Likelihood ratio test showed that the ELN count had the smallest Bayesian information criterion value among the clinicopathologic variables, corresponding to an efficient model to predict outcomes. Subsequently, stage migration of lymph node metastasis was predominantly detected in pN3a patient sub-group with insufficient (less than 16) ELN count, who presented with similar prognosis as the pN3b patients (P = 0.463) as per the stratum analysis with Kaplan-Meier. These methods were further validated using data from the SEER cohort, and the similar promising results were obtained.
pN3a patients with insufficient ELN count should be considered as pN3b cases to achieve accurate prognostic evaluation after curative gastrectomy.
本研究旨在验证在 pN3a 胃癌（GC）患者中，与淋巴结清扫不足（ELN）相关的淋巴结转移分期迁移的可能性。
在中国三家大容量机构中，对 1976 名接受 R0 手术的 pN3 患者进行了研究，以探讨淋巴结受累的分期迁移，并使用来自监测、流行病学和最终结果（SEER）计划登记处的 3146 名 pN3 病例作为外部验证队列。
在中国队列进行倾向评分匹配后，基于单因素和多因素生存分析，ELN 计数作为 GC 结局的独立预测因子，被证实与 pN3a 患者的淋巴结转移分期迁移相关。采用逻辑回归阐明 ELN 计数是根治性手术后 GC 患者长期生存状态的独立相关因素。似然比检验表明，在临床病理变量中，ELN 计数的贝叶斯信息准则值最小，是预测结局的有效模型。随后，在 ELN 计数不足（<16）的 pN3a 患者亚组中主要检测到淋巴结转移的分期迁移，根据 Kaplan-Meier 分层分析，其预后与 pN3b 患者相似（P=0.463）。这些方法在 SEER 队列的数据中得到了进一步验证，得到了类似的有前景的结果。
对于根治性胃切除术后，应将 ELN 计数不足的 pN3a 患者视为 pN3b 病例，以实现准确的预后评估。
