Zhao Ri-Sheng, Liu Yi-Nan, Dai Wei-Gang, Chen Si-Le, Ye Jin-Ning, Zhai Er-Tao, Cai Shi-Rong, Chen Jian-Hui
Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2021 Mar 5;11:624413. doi: 10.3389/fonc.2021.624413. eCollection 2021.
The impact of lymph nodes (LNs) removed on the survivals of patients with stage III gastric cancer, especially on that of those who undergo the adjuvant chemotherapy as a compensation for a possibly insufficient lymphadenectomy, is still unclear.
Consecutive patients (n = 488) with stage III gastric cancer under R0 curative resection followed by adjuvant chemotherapy were analyzed. The overall survival (OS) was compared between patients with insufficient LNs removed (ILNr, <16 LNs) and sufficient LNs removed (SLNr, ≥16 LNs). Performance of the prediction systems was evaluated using the Likelihood ratio χ test, Akaike information criterion (AIC), Harrell's concordance index (C-index), and area under the receiver operating characteristic curves (AUC).
The OS of patients were significantly longer in those with SLNr relative to those with ILNr (for stage IIIA, 68.2 vs. 43.2 months, = 0.042; for stage IIIB, 43.7 vs. 24.9 months, < 0.001; for stage IIIC, 23.9 vs. 8.3 months, < 0.001; and for total stage III, 37.7 vs. 21.7 months, < 0.001). However, the OS were similar between stage IIIA patients with ILNr and stage IIIB patients with SLNr ( = 0.928), between IIIB patients with ILNr and IIIC patients with SLNr ( = 0.962), and IIIC patients with ILNr and stage IV ( = 0.668), respectively. A substage increase in the AJCC classification system, from IIIA to IIIB, from IIIB to IIIC, and from IIIC to IV in patients with ILNr, enhanced the accuracy of prognostic prediction in patients with stage III gastric cancer compared to the current TNM system (Likelihood ratio χ, 188.6 vs. 184.8; AIC, 4336.4 vs. 4340.6; C-index, 0.695 vs. 0.679, = 0.002). The ROC curves revealed that the performance of prognostic prediction was better in the new prediction system (AUC = 0.699) compared with the current TNM system (AUC = 0.676).
ILNr (LNs <16) impairs the long-term outcomes of stage III gastric cancer underwent adjuvant chemotherapy. The status of LNs removal adds values to the current TNM system in prognostic prediction of stage III gastric cancer.
切除的淋巴结数量对Ⅲ期胃癌患者生存的影响尚不清楚，尤其是对那些接受辅助化疗以弥补可能存在的淋巴结清扫不充分的患者。
对488例接受R0根治性切除并随后进行辅助化疗的Ⅲ期胃癌患者进行连续分析。比较淋巴结清扫不充分（ILNr，<16枚淋巴结）和淋巴结清扫充分（SLNr，≥16枚淋巴结）患者的总生存期（OS）。使用似然比χ检验、赤池信息准则（AIC）、哈雷尔一致性指数（C-index）和受试者工作特征曲线下面积（AUC）评估预测系统的性能。
SLNr患者的OS明显长于ILNr患者（ⅢA期，68.2个月对43.2个月，P = 0.042；ⅢB期，43.7个月对24.9个月，P < 0.001；ⅡIC期，23.9个月对8.3个月，P < 0.001；总Ⅲ期，37.7个月对21.7个月，P < 0.001）。然而，ILNr的ⅢA期患者与SLNr的ⅢB期患者之间的OS相似（P = 0.928），ILNr的ⅢB期患者与SLNr的ⅡIC期患者之间的OS相似（P = 0.962），ILNr的ⅡIC期患者与Ⅳ期患者之间的OS相似（P = 0.668）。与目前的TNM系统相比，ILNr患者中AJCC分类系统从ⅢA期到ⅢB期、从ⅢB期到ⅡIC期以及从ⅡIC期到Ⅳ期的亚分期增加提高了Ⅲ期胃癌患者预后预测的准确性（似然比χ，188.6对184.8；AIC，4336.4对4340.6；C-index，0.695对0.679，P = 0.002）。ROC曲线显示，新的预测系统的预后预测性能优于目前的TNM系统（AUC = 0.699）（AUC = 0.676）。
ILNr（淋巴结<16枚）会损害接受辅助化疗的Ⅲ期胃癌患者的长期预后。淋巴结清扫状态在Ⅲ期胃癌的预后预测中为目前的TNM系统增加了价值。
