First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
Department of Pathology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
Surg Today. 2022 Jan;52(1):61-68. doi: 10.1007/s00595-021-02302-9. Epub 2021 May 22.
The clinical significance of lymph node micrometastasis (LNMM) remains controversial in gastric cancer (GC). In this study, we investigated the prognostic impact of LNMM in patients with GC.
A total of 624 patients with pathologically lymph node metastasis-negative (pN0) and N1 status (pN1) who underwent gastrectomy between 2004 and 2018 were enrolled in this retrospective study. The diameter of tumor cell clusters in metastatic lymph nodes was measured in 120 patients with pN1 GC.
Patients with lymph node tumors < 1500 μm in diameter (LNMM) had a significantly better prognosis than those with tumors ≥ 1500 μm in diameter (p = 0.012; log-rank test). Cox's proportional hazards model revealed that LNMM (p = 0.016), several dissected lymph nodes (p = 0.049), and the provision of adjuvant chemotherapy (p = 0.002) were independent prognostic factors for the overall survival of patients with pN1 GC. There was no significant difference in the overall survival between patients with LNMM who received chemotherapy and those who did not (p = 0.332).
LNMM is associated with a favorable prognosis and maybe an independent prognostic marker in patients with pN1 GC. LNMM in GC may be considered a factor preventing adjuvant chemotherapy.
淋巴结微转移（LNMM）在胃癌（GC）中的临床意义仍存在争议。本研究旨在探讨 LNMM 对 GC 患者的预后影响。
本回顾性研究纳入了 2004 年至 2018 年间接受胃切除术且病理淋巴结转移阴性（pN0）和 N1 状态（pN1）的 624 例患者。对 120 例 pN1 GC 患者的转移性淋巴结中肿瘤细胞簇的直径进行了测量。
肿瘤直径<1500μm（LNMM）的患者预后明显优于肿瘤直径≥1500μm（p=0.012；对数秩检验）。Cox 比例风险模型显示，LNMM（p=0.016）、解剖的淋巴结数量（p=0.049）和辅助化疗的提供（p=0.002）是 pN1 GC 患者总生存率的独立预后因素。接受化疗的 LNMM 患者与未接受化疗的患者的总生存率无显著差异（p=0.332）。
LNMM 与 pN1 GC 患者的良好预后相关，可能是独立的预后标志物。GC 中的 LNMM 可能被认为是预防辅助化疗的一个因素。
