Miwa K, Miyazaki I, Sahara H, Fujimura T, Yonemura Y, Noguchi M, Falla R
Surgery II, School of Medicine, Kanazawa University, Japan.
Br J Cancer. 1995 Dec;72(6):1518-24. doi: 10.1038/bjc.1995.540.
The incidence of nodal metastasis in early gastric carcinoma (EGC) is 10-20%. However, the optimal nodal dissection for early gastric carcinoma has not been established. A retrospective study was conducted in 392 consecutive patients who underwent potentially curative distal gastrectomy for EGC between 1962 and 1990. Of these 295 patients treated after September 1972 were prospectively entered into an extensive lymphadenectomy protocol. These patients were compared with 97 patients with simple gastrectomy in respect of the causes of death after surgery and the 10 year disease-specific survival rate. The incidence of nodal metastasis in early gastric carcinoma patients was 13.0%. Operative mortality from extensive lymphadenectomy was almost the same as from simple gastrectomy (2.0% and 2.1% respectively). Extensive lymphadenectomy provided a significantly higher 10 year survival rate than limited lymph node dissection (97.9% vs 88.1% respectively; P < 0.005). Among patients with nodal metastasis, the survival rate following extensive lymphadenectomy was significantly higher than that after simple gastrectomy (87.5% vs 55.6%; P = 0.018). Among patients without nodal metastasis, there was no difference between the two groups in the survival rate (99.4% and 96.7% respectively; P = 0.12). Multivariate analysis using the Cox proportional hazards model disclosed two significant independent prognostic factors on disease-specific survival, the nodal involvement (risk ratio: 8.4; P < 0.0001) and the extent of lymph node dissection (risk ratio: 5.8; P < 0.005). Extensive nodel dissection appears to prevent recurrence and to improve the cancer-specific survival in EGC patients with nodal metastasis.
早期胃癌（EGC）的淋巴结转移发生率为10%-20%。然而，早期胃癌的最佳淋巴结清扫方式尚未确定。对1962年至1990年间连续392例行EGC根治性远端胃切除术的患者进行了一项回顾性研究。其中，1972年9月后治疗的295例患者前瞻性地纳入了广泛淋巴结清扫方案。将这些患者与97例行单纯胃切除术的患者在术后死亡原因和10年疾病特异性生存率方面进行比较。早期胃癌患者的淋巴结转移发生率为13.0%。广泛淋巴结清扫的手术死亡率与单纯胃切除术几乎相同（分别为2.0%和2.1%）。广泛淋巴结清扫的10年生存率显著高于有限淋巴结清扫（分别为97.9%和88.1%；P<0.005）。在有淋巴结转移的患者中，广泛淋巴结清扫后的生存率显著高于单纯胃切除术后（87.5%对55.6%；P=0.018）。在无淋巴结转移的患者中，两组的生存率无差异（分别为99.4%和96.7%；P=0.12）。使用Cox比例风险模型进行多变量分析显示，疾病特异性生存有两个显著的独立预后因素，即淋巴结受累（风险比：8.4；P<0.0001）和淋巴结清扫范围（风险比：5.8；P<0.005）。广泛淋巴结清扫似乎可预防复发并提高有淋巴结转移的EGC患者的癌症特异性生存率。
