在微卫星不稳定型高胃癌的病理检查中需要获得更多的淋巴结。
A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer.
机构信息
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.
Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China.
出版信息
BMC Cancer. 2021 Mar 25;21(1):319. doi: 10.1186/s12885-021-08044-8.
BACKGROUND
The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy.
METHODS
We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT) were calculated in both groups.
RESULTS
Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT for MSI-H and MSS groups were 31 and 25, respectively. TLNT of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%.
CONCLUSIONS
MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.
背景
微卫星状态对淋巴结（LN）切除术中的 LN 产量和病理检查的影响从未在胃癌（GC）中进行过评估。在这项研究中，我们旨在评估高微卫星不稳定性（MSI-H）与根治性胃切除术后 LN 产量之间的关系。
方法
我们回顾性分析了 1757 例接受根治性胃切除术的 GC 患者，将其分为 MSI-H 组（n=185（10.5%））和微卫星稳定（MSS）组（n=1572（89.5%）），使用五个 Bethesda 标志物（NR-24、BAT-25、BAT-26、CAT-25、MONO-27）面板。比较两组间的 LN 计数中位数和至少有 16 个 LN（足够的 LN 比）的标本百分比。计算两组中阳性 LN 计数（PLNC）与阴性 LN 计数（NLNC）的对数优势（LODDS）和目标 LN 检查阈值（TLNT）。
结果
在完整队列中，MSI-H 组和 MSS 组的 LN 计数中位数存在统计学差异（30 对 28，p=0.031），在接受远端胃切除术（DG）的患者中（30 对 27，p=0.002），在接受 DG 的 II 期患者中（34 对 28，p=0.005），在接受 DG 的 LN 阴性患者中（28 对 24，p=0.002）。MSI-H 是 DG 患者总 LN 计数较高的独立因素（p=0.011），但与足够的 LN 比无关。MSI-H GC 和 MSS GC 之间在 PLNC、NLNC 和 LODDS 方面存在统计学差异（均 p<0.001）。MSI-H 组和 MSS 组的 TLNT 分别为 31 和 25。无论 X%的给定值如何，MSI-H GC 的 TLNT 始终高于 MSS GC。
结论
MSI-H 与 GC 患者接受胃切除术后的 LN 产量较高有关。尽管 MSI-H 不影响 LN 采集的充分性，但我们推测在 MSI-H GC 的病理检查中需要更大的淋巴结产量。
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