胃癌根治性切除术后淋巴结比率的复发结局：一项回顾性队列研究。

Recurrence outcome of lymph node ratio in gastric cancer after underwent curative resection: A retrospective cohort study.

作者信息

Supsamutchai Chairat, Wilasrusmee Chumpon, Jirasiritham Jakrapan, Rakchob Teerawut, Phosuwan Songpol, Chatmongkonwat Tanet, Choikrua Pattawia, Thampongsa Tharin

机构信息

Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.

出版信息

Ann Med Surg (Lond). 2020 Apr 19;54:57-61. doi: 10.1016/j.amsu.2020.04.002. eCollection 2020 Jun.

DOI:10.1016/j.amsu.2020.04.002

PMID:32373343

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7191314/

Abstract

INTRODUCTION

D2 dissection has been regarded as the standard procedure for locally advanced gastric cancer (GC). Number of lymph nodes (LN) harvested is an important factor for accurate staging. The number of LN retrieved and the metastasis LN status are also important factors to determine the prognosis. This study aims to evaluate whether lymph node ratio (LNR) could be a prognostic indicator of GC patients following curative resection.

PATIENTS AND METHODS

Single center retrospective cohort study of GC patients underwent curative resection from January 1995 to December 2016 was conducted. The patients were categorized into 3 groups based on LNR (0.00-0.35, >0.35-0.75, and >0.75-1.00) and 2 groups based on number of LN retrieved (<15 and ≥ 15). Kaplan-Meier method was used to estimate recurrence-free survival. Cox-regression were used to determine the association between LNR/other factors and the disease recurrence.

RESULTS

One-hundred fifty-three patients were included in analysis. Univariate analysis showed that LNR >0.35, pathologic LN stages (pN) 2-3, higher number of LN metastasis, and TNM stage III were significantly recurrence risk factors. After adjusting for several covariates, LNR >0.35 still was significant predictor (adjusted HR [95%CI], 8.53 [1.97, 36.86]; = 0.004) while number of LN retrieved or number of metastasis LN were not.

CONCLUSION

LNR could be a strong indicator for the recurrence of GC after curative resection while the number of LN retrieved or metastasis did not predict the recurrence. Future studies, such as prospective studies, are needed to confirm and identify the optimum LNR cut-off.

摘要

引言

D2 根治术一直被视为局部进展期胃癌（GC）的标准手术方式。获取的淋巴结（LN）数量是准确分期的重要因素。获取的 LN 数量以及转移 LN 状态也是决定预后的重要因素。本研究旨在评估淋巴结比率（LNR）是否可作为 GC 患者根治性切除术后的预后指标。

患者与方法

对 1995 年 1 月至 2016 年 12 月期间接受根治性切除的 GC 患者进行单中心回顾性队列研究。根据 LNR（0.00 - 0.35、>0.35 - 0.7 < 0.75 和 >0.75 - 1.00）将患者分为 3 组，根据获取的 LN 数量（<15 和≥15）分为 2 组。采用 Kaplan-Meier 方法估计无复发生存率。使用 Cox 回归确定 LNR/其他因素与疾病复发之间的关联。

结果

153 例患者纳入分析。单因素分析显示，LNR >0.35、病理 LN 分期（pN）2 - 3、较高的 LN 转移数量和 TNM 分期 III 是显著的复发危险因素。在调整了多个协变量后，LNR >0.35 仍然是显著的预测因素（调整后 HR [95%CI]，8.53 [1.97, 36.86]；P = = 0.004），而获取的 LN 数量或转移 LN 数量则不是。