Shu Ping, Sun Xiangfei, Liu Fenglin, Fang Yong, Shen Kuntang, Sun Yihong, Qin Jing, Qin Xinyu
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Chin J Cancer Res. 2021 Feb 28;33(1):61-68. doi: 10.21147/j.issn.1000-9604.2021.01.07.
The current standard D2 lymphadenectomy for gastric cancer (GC) includes dissection of lymph nodes (LNs) along the proper hepatic artery (No. 12a), however, the survival benefit remains controversial. The purpose of this study was to evaluate the pattern of No. 12a LN metastasis (LNM) in GC and explore the indications for No. 12a LN dissection.
Medical records of 413 consecutive GC patients who underwent curative surgery in Zhongshan Hospital, Fudan University between January 2015 and December 2018 were enrolled and reviewed retrospectively. The correlation between No. 12a LNM and clinicopathologic characteristics of patients was analyzed.
The overall incidence of No. 12a LNM was 2.67% (11/413). Tumor location (P=0.012), depth of tumor infiltration (P<0.01) and N stage (P=0.018) were significant factors associated with No. 12a LNM. All the tumors with No. 12a LNM involved the lower third of the stomach and were in T3-4 stages. Patients with No. 12a LNM had extensive LNM than those without (20.91±4.25. 5.0±0.54, P<0.001). For advanced GC patients (stage III/IV) with tumors involving the lower third of the stomach, the incidence of No. 12a LNM increased to 10.7% (11/103). Patients with No. 12a LNM had a significantly poorer recurrence-free survival (RFS) (P=0.005) and overall survival (OS) (P=0.017). According to the result of multivariable Cox regression, No. 12a LNM was not an independent impact factor on RFS and OS.
The overall incidence of No. 12a LNM was low but it was much higher in GC patients who had very advanced tumors involving the lower third of the stomach. No. 12a LN dissection should be considered for these patients to improve the survival outcomes.
目前胃癌（GC）的标准D2淋巴结清扫术包括沿肝固有动脉（第12a组）清扫淋巴结（LNs），然而，其生存获益仍存在争议。本研究旨在评估GC中第12a组淋巴结转移（LNM）的模式，并探讨第12a组淋巴结清扫的指征。
纳入并回顾性分析2015年1月至2018年12月在复旦大学附属中山医院接受根治性手术的413例连续GC患者的病历。分析第12a组LNM与患者临床病理特征之间的相关性。
第12a组LNM的总体发生率为2.67%（11/413）。肿瘤位置（P=0.012）、肿瘤浸润深度（P<0.01）和N分期（P=0.018）是与第12a组LNM相关的显著因素。所有发生第12a组LNM的肿瘤均累及胃下三分之一且处于T3-4期。发生第12a组LNM的患者比未发生者有更广泛的LNM（20.91±4.25对5.0±0.54，P<0.001）。对于肿瘤累及胃下三分之一的晚期GC患者（III/IV期），第12a组LNM的发生率增至10.7%（11/103）。发生第12a组LNM的患者无复发生存期（RFS）（P=0.005）和总生存期（OS）（P=0.017）明显更差。根据多变量Cox回归结果，第12a组LNM不是RFS和OS的独立影响因素。
第12a组LNM的总体发生率较低，但在肿瘤累及胃下三分之一的非常晚期的GC患者中要高得多。对于这些患者应考虑行第12a组淋巴结清扫以改善生存结局。
