胃癌术前化疗及手术后残留淋巴结转移在预测复发中的临床意义

Clinical Significance of Residual Lymph Node Metastasis in Predicting Recurrence After Preoperative Chemotherapy and Surgery for Gastric Cancer.

作者信息

Komori Keisuke, Yamada Takanobu, Ando Shuji, Nagasawa Shinsuke, Kanematsu Kyohei, Morita Junya, Tanabe Mie, Nakayama Yuta, Rino Yasushi, Saito Aya, Ogata Takashi, Oshima Takashi

机构信息

Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.

Department of Surgery, International University of Health and Welfare, Atami, Japan.

出版信息

Anticancer Res. 2025 Mar;45(3):1205-1214. doi: 10.21873/anticanres.17507.

DOI:10.21873/anticanres.17507

PMID:40037862

Abstract

BACKGROUND/AIM: Neoadjuvant chemotherapy is gaining recognition for its potential to improve survival outcomes, with combined neoadjuvant and adjuvant therapies under investigation. However, the prognostic significance of post-chemotherapy pathological staging (ypStage) on recurrence-free survival (RFS) remains unclear. This study aimed to evaluate the utility of ypStage, ypT, ypN classification, and histological response rate in predicting recurrence after gastrectomy.

PATIENTS AND METHODS

This retrospective study included 125 patients who underwent radical gastrectomy after preoperative chemotherapy at the Kanagawa Cancer Center between January 2007 and November 2019. RFS was analyzed based on ypStage, ypT, ypN classification, and histological response rate, with prognostic factors also assessed.

RESULTS

The 5-year RFS rates were 81.6% for ypStage I, 49.0% for ypStage II, and 42.9% for ypStage III. Significant differences were observed between ypStage I and ypStage II (=0.025) but not between ypStage II and ypStage III ( =0.633). In ypStage II/III cases, the 5-year RFS rate was significantly higher for ypN0/1/2 (55.4%) compared to ypN3 (21.5%) (=0.003). ypN was selected as an independent predictor for relapse in multivariate analysis.

CONCLUSION

ypStage effectively predicts recurrence in ypStage I cases after preoperative chemotherapy and surgery for gastric cancer. However, prognosis in patients with ypStage II/III is better stratified using the ypN classification, particularly ypN3.

摘要

背景/目的：新辅助化疗因其改善生存结局的潜力而得到认可，新辅助和辅助联合治疗正在研究中。然而，化疗后病理分期（yp分期）对无复发生存期（RFS）的预后意义仍不明确。本研究旨在评估yp分期、ypT、ypN分类和组织学缓解率在预测胃癌切除术后复发中的作用。

患者与方法

本回顾性研究纳入了2007年1月至2019年11月在神奈川县癌症中心接受术前化疗后行根治性胃切除术的125例患者。基于yp分期、ypT、ypN分类和组织学缓解率分析RFS，并评估预后因素。

结果

ypI期的5年RFS率为81.6%，ypII期为49.0%，ypIII期为42.9%。ypI期和ypII期之间观察到显著差异（=0.025），但ypII期和ypIII期之间未观察到显著差异（=0.633）。在ypII/III期病例中，ypN0/1/2的5年RFS率（55.4%）显著高于ypN3（21.5%）（=0.003）。在多变量分析中，ypN被选为复发的独立预测因子。