Department of Radiotherapy and Chemotherapy, The Second Affiliated Hospital of Xingtai Medical College, No. 618 Gangtie North Road, Xingtai, 054000, Hebei Province, China.
Surg Today. 2024 Oct;54(10):1255-1264. doi: 10.1007/s00595-024-02829-7. Epub 2024 Apr 8.
To grade the pathological response of lymph nodes (LNs) to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC) and investigate its prognostic significance.
This retrospective study included 196 patients who underwent NAC, followed by radical gastrectomy for LAGC between January 2010 and October 2019. Pathological responses were evaluated based on the proportion of residual tumor cells within the tumor area in the primary tumor (PT) and LNs and included the following categories: 1a (0%), 1b (< 10%), 2 (10-50%), and 3 (> 50%).
Among 166 patients with clinically node-positive disease, 38/27/39/62 were classified as having LN regression grade (LRG) 1a/1b/2/3, respectively. Compared to LN non-responders (LRG 2 or 3), LN responders (LRG 1a or 1b) had significantly higher 5-year overall survival (72.5% vs. 19.0%, P < 0.001) and recurrence-free survival rates (67.8% vs. 22.2%, P < 0.001), irrespective of PT response. Furthermore, a multivariate analysis revealed that the LN response was an independent risk factor for the overall survival (hazard ratio [HR] 0.417, 95% confidence interval [CI] 0.181-0.962, P = 0.040) and recurrence-free survival (HR 0.490, 95% CI 0.242-0.991, P = 0.047), but not the PT response (P > 0.05).
The pathological LN response may be a reliable prognostic prediction tool in patients with LAGC who received NAC.
对接受新辅助化疗（NAC）的局部晚期胃癌（LAGC）患者的淋巴结（LN）病理反应进行分级，并探讨其预后意义。
本回顾性研究纳入了 2010 年 1 月至 2019 年 10 月期间接受 NAC 治疗后行根治性胃切除术的 196 例 LAGC 患者。根据原发肿瘤（PT）和 LN 内残留肿瘤细胞比例对病理反应进行评估，包括以下类别：1a（0%）、1b（<10%）、2（10-50%）和 3（>50%）。
在 166 例临床淋巴结阳性疾病患者中，38/27/39/62 例分别归类为 LN 消退分级（LRG）1a/1b/2/3。与 LN 无反应者（LRG 2 或 3）相比，LN 反应者（LRG 1a 或 1b）的 5 年总生存率（72.5% vs. 19.0%，P<0.001）和无复发生存率（67.8% vs. 22.2%，P<0.001）显著更高，而与 PT 反应无关。此外，多变量分析显示，LN 反应是总生存（风险比[HR]0.417，95%置信区间[CI]0.181-0.962，P=0.040）和无复发生存（HR 0.490，95%CI 0.242-0.991，P=0.047）的独立危险因素，但不是 PT 反应（P>0.05）。
在接受 NAC 的 LAGC 患者中，LN 的病理反应可能是一种可靠的预后预测工具。
