Caliskan Yildirim Eda, Acikgoz Yusuf, Ergun Yakup, Algin Efnan, Bal Oznur
Dokuz Eylul University, Department of Internal Medicine, Division of Medical Oncology, Izmir, Turkey.
Health Sciences University Ankara City Hospital, Department of Medical Oncology, Ankara, Turkey.
Cancer Manag Res. 2023 Oct 3;15:1085-1096. doi: 10.2147/CMAR.S412270. eCollection 2023.
N3 gastric cancer is characterized by a fairly high lymph node metastasis burden and poor outcome despite optimal therapy. Given the limitations of TNM classification, a comprehensive evaluation tool is necessary to predict the prognosis of patients with N3 gastric cancer who underwent curative surgery. This study aims to explore the outcomes and clinicopathologic prognostic factors affecting the overall survival (OS) of patients with N3 gastric cancer after surgery.
Data on patients with N3 gastric cancer who underwent (sub)total gastrectomy and regional lymph node dissection between November 2005 and September 2018 (n = 169) were analyzed by Cox regression to determine the independent prognostic factors for OS.
The multivariable analysis established that gender, patient performance status, metastatic lymph node ratio (MLNR), tumor grade, and adjuvant chemotherapy are significantly associated with OS. The five-year OS of the study population was 15%. Adjuvant chemoradiotherapy was applied to 72% of the patients, which resulted in an improvement in recurrence-free survival but not OS. Recurrence occurred in 103 (75%) patients, in which the most frequent recurrence site was distant metastasis.
Male gender, poor performance status, grade 3 tumor, MLNR > 0.37, and not receiving adjuvant chemotherapy are predictors of poor prognosis in N3 gastric cancer after curative resection. Considering the high recurrence rates of this group, prospective studies are needed to optimize treatment strategies.
N3期胃癌的特征是淋巴结转移负担相当高，尽管进行了最佳治疗，但其预后仍较差。鉴于TNM分类的局限性，需要一种综合评估工具来预测接受根治性手术的N3期胃癌患者的预后。本研究旨在探讨N3期胃癌患者术后的结局以及影响总生存期（OS）的临床病理预后因素。
对2005年11月至2018年9月期间接受（次）全胃切除术和区域淋巴结清扫的N3期胃癌患者（n = 169）的数据进行Cox回归分析，以确定OS的独立预后因素。
多变量分析确定，性别、患者体能状态、转移淋巴结比率（MLNR）、肿瘤分级和辅助化疗与OS显著相关。研究人群的五年OS为15%。72%的患者接受了辅助放化疗，这使无复发生存期得到改善，但OS未改善。103例（75%）患者出现复发，其中最常见的复发部位是远处转移。
男性、体能状态差、3级肿瘤、MLNR>0.37以及未接受辅助化疗是N3期胃癌根治性切除术后预后不良的预测因素。考虑到该组的高复发率，需要进行前瞻性研究以优化治疗策略。
