de Manzoni G, Verlato G, Guglielmi A, Laterza E, Genna M, Cordiano C
First Department of General Surgery, University of Verona, Italy.
Br J Surg. 1996 Nov;83(11):1604-7. doi: 10.1002/bjs.1800831137.
The results for 162 patients who underwent curative gastrectomy for gastric cancer from January 1988 to June 1994 were analysed statistically with special reference to the effect of lymph node dissection. Median survival was 69.3 months and the overall cumulative 5-year survival rate was 50.2 (95 per cent confidence interval (c.i.) 41.6-58.1) per cent. By univariate analysis age, histology, depth of tumour invasion, node involvement, number of metastatic lymph nodes and type of lymphadenectomy were found to be significant factors related to survival time. Multivariate analysis with the Cox model and stratified for tumour node metastasis stage revealed that only the number of metastatic nodes (P = 0.04) and the extent of lymphadenectomy (P = 0.003) affected survival independently. With respect to D1 lymphadenectomy, the relative risk associated with D2 and D4 lymphadenectomy was respectively 0.61 (95 per cent c.i. 0.34-1.10) and 0.26 (95 per cent c.i. 0.12-0.60). The 5-year survival rate was 28 per cent for patients who had a D1 dissection, 63 per cent for those who had D2 and 68 per cent for those who had D4. These results suggest that extended lymphadenectomy (D2) and especially superextended lymphadenectomy (D4) can improve survival in patients with gastric cancer.
对1988年1月至1994年6月期间接受胃癌根治性胃切除术的162例患者的结果进行了统计学分析，特别参考了淋巴结清扫的效果。中位生存期为69.3个月，总体累积5年生存率为50.2%（95%置信区间（c.i.）41.6 - 58.1）。单因素分析发现年龄、组织学类型、肿瘤浸润深度、淋巴结受累情况、转移淋巴结数量和淋巴结清扫类型是与生存时间相关的显著因素。采用Cox模型进行多因素分析并按肿瘤淋巴结转移分期分层后发现，只有转移淋巴结数量（P = 0.04）和淋巴结清扫范围（P = 0.003）独立影响生存。关于D1淋巴结清扫，与D2和D4淋巴结清扫相关的相对风险分别为0.61（95% c.i. 0.34 - 1.10）和0.26（95% c.i. 0.12 - 0.60）。接受D1清扫的患者5年生存率为28%，接受D2清扫的患者为63%，接受D4清扫的患者为68%。这些结果表明，扩大淋巴结清扫术（D2）尤其是超扩大淋巴结清扫术（D4）可提高胃癌患者的生存率。
