Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.
Eur J Surg Oncol. 2021 Aug;47(8):2004-2009. doi: 10.1016/j.ejso.2020.12.015. Epub 2020 Dec 30.
We evaluated the significance of lymph node dissection for gastric neuroendocrine carcinoma (NEC) by calculating the therapeutic value index for each station.
This study included 2164 advanced gastric cancer patients (common-type [Common-GC], n = 2125; and gastric NEC [NEC-GC], n = 39). Clinicopathological data were collected, and survival, type of recurrence, and the index for each type of gastrectomy were determined.
NEC-GC was characterized by an older population (P = 0.009), upper tumor location (P = 0.021), frequent venous invasion (P < 0.001), and less neural invasion (P = 0.043). NEC-GC tended to be more frequent in men (P = 0.152), and to be associated with total gastrectomy (P = 0.177) and M1 cases (P = 0.167). The five-year overall survival rates of the Common-GC and NEC-GC groups were 73.8% (95% confidence interval: 71.8-75.6) and 54.7% (37.5-68.9), respectively (P = 0.016). Both groups showed similar index values in each station. Regarding the index of the peri-gastric nodal station (D1 station)/stations away from the stomach (D2 station), although the index of the D1 station was similar in the two groups (41.3 and 43.1), the index of the D2 station in the NEC-GC group was approximately half that of the Common-GC group (10.0 and 5.3). The total recurrence rates of the two groups were similar (P = 0.871). However, the rates of hematogenous and lymphatic recurrence tended to be higher in the NEC-GC group (P = 0.132 and P = 0.152).
The therapeutic efficacy of the D1 station was similar in Common-GC and NEC-GC but that of the D2 station was worse in NEC-GC. Gastrectomy with D2 dissection would be less effective for NEC-GC.
我们通过计算每个站点的治疗价值指数来评估胃神经内分泌癌（NEC）淋巴结清扫的意义。
本研究纳入了 2164 例晚期胃癌患者（普通型[Common-GC]，n=2125；胃 NEC [NEC-GC]，n=39）。收集临床病理资料，确定每种胃切除术的生存、复发类型和指数。
NEC-GC 的特点是患者年龄较大（P=0.009）、肿瘤位置较高（P=0.021）、静脉侵犯频繁（P<0.001）且神经侵犯较少（P=0.043）。NEC-GC 多见于男性（P=0.152），与全胃切除术（P=0.177）和 M1 病例（P=0.167）相关。Common-GC 和 NEC-GC 组的五年总生存率分别为 73.8%（95%置信区间：71.8-75.6）和 54.7%（37.5-68.9），差异有统计学意义（P=0.016）。两组在各站的指数值相似。对于胃旁淋巴结站（D1 站）/远离胃的淋巴结站（D2 站）的指数，尽管两组的 D1 站指数相似（41.3 和 43.1），但 NEC-GC 组的 D2 站指数约为 Common-GC 组的一半（10.0 和 5.3）。两组的总复发率相似（P=0.871）。然而，NEC-GC 组的血行和淋巴复发率较高（P=0.132 和 P=0.152）。
Common-GC 和 NEC-GC 的 D1 站治疗效果相似，但 NEC-GC 的 D2 站效果较差。对于 NEC-GC，D2 淋巴结清扫的胃切除术效果可能较差。
