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转移性淋巴结解剖区域在胃癌当前TNM分期中的预后价值

Prognostic Value of the Anatomic Region of Metastatic Lymph Nodes in the Current TNM Staging of Gastric Cancer.

作者信息

Jeong Oh, Jung Mi Ran, Kang Ji Hoon

机构信息

Department of Surgery, Chonnam National University Medical School, Hwasun, Korea.

出版信息

J Gastric Cancer. 2021 Sep;21(3):236-245. doi: 10.5230/jgc.2021.21.e22. Epub 2021 Aug 4.

DOI:10.5230/jgc.2021.21.e22
PMID:34691808
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8505123/
Abstract

PURPOSE

The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system.

MATERIALS AND METHODS

We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage.

RESULTS

In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01-1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage.

CONCLUSIONS

The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.

摘要

目的

在目前的胃癌肿瘤淋巴结转移（TNM）分期中，数字N分期已取代了拓扑N分期。然而，拓扑N分期在当前TNM分期系统中的实用性尚不确定。我们旨在研究拓扑N分期在当前TNM分期系统中的预后价值。

材料与方法

我们回顾了3350例行根治性胃切除术的胃癌患者的数据。将转移淋巴结（MLNs）的解剖区域分为2组：胃周和胃周外。使用多变量预后模型分析解剖区域的预后价值，并对TNM分期进行调整。

结果

在有淋巴结转移的患者中，胃周外转移的生存率明显低于单纯胃周转移（5年生存率分别为39.6%和73.1%，P<0.001）。在相同的pN分期内，胃周外转移的生存率明显更差；多变量分析表明，胃周外转移是一个独立的不良预后因素（风险比=1.33；95%置信区间=1.01-1.75）。MLNs的解剖区域改善了使用TNM分期的预后模型的拟合优度（似然比统计量，4.57；P=0.033）。

结论

在目前胃癌的TNM分期中，MLNs的解剖区域在数字N分期中具有独立的预后价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/d707ca8f7ec9/jgc-21-236-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/f58044386847/jgc-21-236-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/59d809355fc4/jgc-21-236-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/d707ca8f7ec9/jgc-21-236-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/f58044386847/jgc-21-236-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/59d809355fc4/jgc-21-236-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6527/8505123/d707ca8f7ec9/jgc-21-236-g003.jpg

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