Zhuo Meng, Tian Lei, Han Ting, Liu Teng-Fei, Lin Xiao-Lin, Xiao Xiu-Ying
Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):833-843. doi: 10.4251/wjgo.v16.i3.833.
Traditional lymph node stage (N stage) has limitations in advanced gastric remnant cancer (GRC) patients; therefore, establishing a new predictive stage is necessary.
To explore the predictive value of positive lymph node ratio (LNR) according to clinicopathological characteristics and prognosis of locally advanced GRC.
Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed. The relationship between LNR and clinicopathological characteristics was analyzed. The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.
Number of metastatic LNs, tumor diameter, depth of tumor invasion, Borrmann type, serum tumor biomarkers, and tumor-node-metastasis (TNM) stage were correlated with LNR stage and N stage. Univariate analysis revealed that the factors affecting survival included tumor diameter, anemia, serum tumor biomarkers, vascular or neural invasion, combined resection, LNR stage, N stage, and TNM stage (all < 0.05). The median survival time for those with LNR0, LNR1, LNR2 and LNR3 stage were 61, 31, 23 and 17 mo, respectively, and the differences were significant ( = 0.000). Anemia, tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis (all < 0.05).
The new LNR stage is uniquely based on number of metastatic LNs, with significant prognostic value for locally advanced GRC, and could better differentiate overall survival, compared with N stage.
传统的淋巴结分期（N分期）在晚期残胃癌（GRC）患者中存在局限性；因此，有必要建立一种新的预测分期。
探讨阳性淋巴结比率（LNR）对局部晚期GRC患者临床病理特征及预后的预测价值。
回顾性分析74例行根治性胃切除术及淋巴结清扫术的局部晚期GRC患者。分析LNR与临床病理特征之间的关系。采用Kaplan-Meier生存曲线和Cox回归模型进行生存分析。
转移淋巴结数量、肿瘤直径、肿瘤浸润深度、Borrmann分型、血清肿瘤生物标志物以及肿瘤-淋巴结-转移（TNM）分期均与LNR分期和N分期相关。单因素分析显示，影响生存的因素包括肿瘤直径、贫血、血清肿瘤生物标志物、血管或神经侵犯、联合切除、LNR分期、N分期和TNM分期（均P<0.05）。LNR0、LNR1、LNR2和LNR3期患者的中位生存时间分别为61、31、23和17个月，差异有统计学意义（P=0.000）。多因素分析显示，贫血、肿瘤生物标志物和LNR分期是生存的独立预后因素（均P<0.05）。
新的LNR分期独特地基于转移淋巴结数量，对局部晚期GRC具有显著的预后价值，与N分期相比，能更好地区分总生存期。
