Dong Yin-Ping, Cai Feng-Lin, Wu Zi-Zhen, Wang Peng-Liang, Yang Yang, Guo Shi-Wei, Zhao Zhen-Zhen, Zhao Fu-Cheng, Liang Han, Deng Jing-Yu
Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy at Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy at Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
World J Gastrointest Surg. 2021 Nov 27;13(11):1390-1404. doi: 10.4240/wjgs.v13.i11.1390.
Controversy over the issue that No. 12a lymph node involvement is distant or regional metastasis remains, and the possible inclusion of 12a lymph nodes in D2 lymphadenectomy is unclear. As reported, gastric cancer (GC) located in the lower third is highly related to the metastasis of station 12a lymph nodes.
To investigate whether the clinicopathological factors and metastasis status of other perigastric nodes can predict station 12a lymph node metastasis and evaluate the prognostic significance of station 12a lymph node dissection in patients with lower-third GC.
A total of 147 patients with lower-third GC who underwent D2 or D2+ lymphadenectomy, including station 12a lymph node dissection, were included in this retrospective study from June 2003 to March 2011. Survival prognoses were compared between patients with or without station 12a lymph node metastasis. Logistic regression analyses were used to clarify the association between station 12a lymph node metastasis and clinicopathological factors or metastasis status of other perigastric nodes. The metastasis status of each regional lymph node was evaluated to identify the possible predictors of station 12a lymph node metastasis.
Metastasis to station 12a lymph nodes was observed in 18 patients with lower-third GC, but not in 129 patients. The incidence of station 12a lymph node involvement was reported as 12.2% in patients with lower-third GC. The overall survival of patients without station 12a lymph node metastasis was significantly better than that of patients with station 12a metastasis ( < 0.001), which could also be seen in patients with or without extranodal soft tissue invasion. Station 12a lymph node metastasis and extranodal soft tissue invasion were identified as independent predictors of poor prognosis in patients with lower-third GC. Advanced pN stage was defined as independent risk factor significantly correlated with station 12a lymph node positivity. Station 3 lymph node staus was also proven to be significantly correlated with station 12a lymph node involvement.
Metastasis of station 12a lymph nodes could be considered an independent prognosis factor for patients with lower-third GC. The dissection of station 12a lymph nodes may not be ignored in D2 or D2+ lymphadenectomy due to difficulties in predicting station 12a lymph node metastasis.
关于第12a组淋巴结转移属于远处转移还是区域转移的问题仍存在争议，并且在D2淋巴结清扫术中是否可能包括第12a组淋巴结尚不清楚。据报道，位于胃下1/3的胃癌（GC）与第12a组淋巴结转移高度相关。
探讨胃周其他淋巴结的临床病理因素和转移状态是否可预测第12a组淋巴结转移，并评估胃下1/3 GC患者中第12a组淋巴结清扫的预后意义。
本回顾性研究纳入了2003年6月至2011年3月期间共147例行D2或D2+淋巴结清扫术（包括第12a组淋巴结清扫）的胃下1/3 GC患者。比较有或无第12a组淋巴结转移患者的生存预后。采用逻辑回归分析来阐明第12a组淋巴结转移与临床病理因素或胃周其他淋巴结转移状态之间的关联。评估每个区域淋巴结的转移状态以确定第12a组淋巴结转移的可能预测因素。
147例胃下1/3 GC患者中，18例出现第12a组淋巴结转移，129例未出现。胃下1/3 GC患者中第12a组淋巴结受累的发生率为12.2%。无第12a组淋巴结转移患者的总生存期明显优于有第12a组转移的患者（<0.001），在有或无结外软组织侵犯的患者中也可见此情况。第12a组淋巴结转移和结外软组织侵犯被确定为胃下1/3 GC患者预后不良的独立预测因素。进展期pN分期被定义为与第12a组淋巴结阳性显著相关的独立危险因素。第3组淋巴结状态也被证明与第12a组淋巴结受累显著相关。
第12a组淋巴结转移可被视为胃下1/3 GC患者的独立预后因素。由于预测第12a组淋巴结转移存在困难，在D2或D2+淋巴结清扫术中第12a组淋巴结的清扫可能不容忽视。
