National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Cancer Sci. 2021 Aug;112(8):3266-3277. doi: 10.1111/cas.15003. Epub 2021 Jul 2.
The argument concerning the exact minimum number of examined lymph nodes (ELNs) has continued for a long time among various regions, and no consensus has been reached for stratified pathological T stages for data to date. Data from 4607 pN0 patients with gastric cancer were analyzed. Kaplan-Meier analysis showed the similar overall survival (OS) outcomes among the 3 groups (ELNs ≤ 15, 16 ≤ ELNs ≤ 29 and ELNs ≥ 30, P = .171). However, the ELNs ≥ 30 group had a better disease-free survival (DFS) outcome compared with the others (all P < .05). An increased ELN group (ELNs ≥ 30) showed an improved OS only for pT3 patients (hazard ratio [HR] = 0.397, 95% confidence interval (CI): 0.182-0.866, P = .020), while an improved DFS for pT3 patients (HR = 0.362, 95%CI: 0.152-0.860, P = .021) and pT4 patients (HR = 0.484, 95%CI: 0.277-0.844, P = .011) in the multivariate analysis. A well discriminated and calibrated nomogram was constructed to predict the probability of the OS and DFS, with the C-index for OS and DFS prediction of 0.782 (95%CI: 0.735 to 0.829) and 0.738 (95%CI: 0.685 to 0.791), respectively. This study provides new and useful insights into the impact of ELN count on reducing stage migration and postoperative recurrence of pN0 patients with gastric cancer in 2000-2017. In conclusion, a larger number of ELNs is suggested for surgeons to prolong the prognosis of pN0 gastric cancer, especially for pT3 patients.
目前的数据尚未就分层病理 T 分期达成共识，因此不同地区之间关于确切的最小检查淋巴结数量（ELN）的争论仍在继续。对 4607 例胃癌 pN0 患者的数据进行了分析。Kaplan-Meier 分析显示，3 组患者的总生存（OS）结局相似（ELN≤15、16≤ELN≤29 和 ELN≥30，P=0.171）。然而，ELN≥30 组的无病生存（DFS）结果优于其他两组（均 P<0.05）。增加 ELN 组（ELN≥30）仅显示对 pT3 患者的 OS 改善（风险比[HR]=0.397，95%置信区间[CI]：0.182-0.866，P=0.020），DFS 改善仅对 pT3 患者（HR=0.362，95%CI：0.152-0.860，P=0.021）和 pT4 患者（HR=0.484，95%CI：0.277-0.844，P=0.011）有意义。在多变量分析中，构建了一个区分度和校准度良好的列线图来预测 OS 和 DFS 的概率，OS 和 DFS 预测的 C 指数分别为 0.782（95%CI：0.735-0.829）和 0.738（95%CI：0.685-0.791）。本研究为 2000-2017 年 ELN 计数对减少胃癌 pN0 患者的分期迁移和术后复发的影响提供了新的有用见解。总之，建议外科医生增加 ELN 的数量，以延长 pN0 胃癌患者的预后，特别是对 pT3 患者。
