Chen Xinhua, Chen Yuehong, Hu Yanfeng, Lin Tian, Luo Jun, Li Tuanjie, Li Tao, Huang HuiLin, Zhu Yu, Li Tingting, Chen Hao, Liu Hao, Li Guoxin, Yu Jiang
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Oncol. 2020 Feb 12;10:123. doi: 10.3389/fonc.2020.00123. eCollection 2020.
The number of retrieved lymph nodes (RLNs) affects the likelihood of detecting metastatic lymph nodes (MLNs) for gastric cancer (GC), but the retrieval of LNs is not satisfactory worldwide. There is no standard for LN examination. We retrospectively analyzed 2,163 patients diagnosed with GC who underwent surgery at Nanfang Hospital between October 2004 and September 2016. According to the methods of LN examination, patients were classified into two groups: LN detection by pathologists (pathologist group) and LN examination by surgicopathologic team (surgicopathologist group). The relationship between RLNs and LN staging accuracy as well as the factors influencing the detection of MLNs were evaluated. There were 472 males in pathologist group and 467 males in surgicopathologist group. The number of RLNs and MLNs in surgicopathologist group was significantly higher than that in pathologist group (RLNs: 53.8 ± 20.9 vs. 18.8 ± 11.5, < 0.001; MLNs: 5.6 ± 9.8 vs. 3.9 ± 5.7, < 0.001). Notably, the detection of N3b node status was significantly improved in surgicopathologist group [83 (11.9%) vs. 34 (4.8%), < 0.001]. Additionally, the detection rate of N3b status gradually increased from 0 in patients with 1-16 RLNs to 16.6% in patients with more than 49 RLNs. The MLNs detected increased gradually from 2.3 ± 3.0 in patients with 1-16 RLNs to 7.3 ± 11.7 in patients with more than 49 RLNs. Univariate and multivariate analyses indicated that LN examination by surgicopathologic team, more advanced pT, tumor size ≥5 cm and combined organ(s) resection were related to detecting more MLNs. The retrieval of nodes immediately postoperatively by the surgicopathologic team could significantly improve the number of RLNs, detect more MLNs, and screen more patients with N3b node status.
获取的淋巴结数量（RLNs）会影响胃癌（GC）患者检测到转移性淋巴结（MLNs）的可能性，但在全球范围内，淋巴结的获取情况并不理想。目前尚无淋巴结检查的标准。我们回顾性分析了2004年10月至2016年9月间在南方医院接受手术的2163例确诊为GC的患者。根据淋巴结检查方法，将患者分为两组：病理科医生检测淋巴结（病理医生组）和外科病理团队检查淋巴结（外科病理医生组）。评估了RLNs与淋巴结分期准确性之间的关系以及影响MLNs检测的因素。病理医生组有472名男性，外科病理医生组有467名男性。外科病理医生组的RLNs和MLNs数量显著高于病理医生组（RLNs：53.8±20.9对18.8±11.5，<0.001；MLNs：5.6±9.8对3.9±5.7，<0.001）。值得注意的是，外科病理医生组中N3b淋巴结状态的检测显著改善[83例（11.9%）对34例（4.8%），<0.001]。此外，N3b状态的检测率从1 - 16个RLNs患者的0逐渐增加到超过49个RLNs患者的16.6%。检测到的MLNs从1 - 16个RLNs患者的2.3±3.0逐渐增加到超过49个RLNs患者的7.3±11.7。单因素和多因素分析表明，外科病理团队进行淋巴结检查、更晚期的pT、肿瘤大小≥5 cm以及联合器官切除与检测到更多的MLNs有关。外科病理团队在术后立即获取淋巴结可显著增加RLNs数量，检测到更多的MLNs，并筛查出更多N3b淋巴结状态的患者。
