Ichikura T, Furuya Y, Tomimatsu S, Okusa Y, Ogawa T, Mukoda K, Mochizuki H, Tamakuma S
First Department of Surgery, National Defense Medical College Hospital, Namiki, Tokorozawa, Japan.
Surg Today. 1998;28(9):879-83. doi: 10.1007/s005950050246.
To evaluate the rationality of the current nodal staging system in gastric cancer, we retrospectively analyzed 152 patients with perigastric node involvement localized to a single station, in whom the route of metastasis to distant nodes was limited. No significant differences in pathology or survival were observed between patients with stage n1 and those with stage n2-3 nodal involvement, but the mean (standard deviation) number of perigastric nodes dissected was 22.6 (12.6) in those with stage nl involvement and 18.5 (9.5) in those with stage n2-3 involvement (P = 0.04). When perigastric node involvement was localized to station 3, the mean number of dissected station 3 nodes was 7.7 (4.2) in nl patients and 5.3 (2.8) in n2-3 patients (P = 0.04). This tendency was also observed in patients with perigastric node involvement limited to either station 1 (P = 0.08) or station 6 (P = 0.11). Thus, patients with fewer perigastric nodes may have more lymphatics that bypass perigastric nodes and empty directly into distant nodes, increasing the likelihood of skip metastases. The number of positive nodes, affected to a lesser degree by lymphatic distribution than the location of positive nodes, should be incorporated into the staging criteria.
为评估当前胃癌区域淋巴结分期系统的合理性，我们回顾性分析了152例胃周淋巴结受累局限于单一区域且远处淋巴结转移途径有限的患者。n1期患者与n2 - 3期淋巴结受累患者在病理或生存率方面未观察到显著差异，但n1期受累患者胃周淋巴结清扫的平均（标准差）数量为22.6（12.6）个，n2 - 3期受累患者为18.5（9.5）个（P = 0.04）。当胃周淋巴结受累局限于第3区域时，n1期患者第3区域清扫淋巴结的平均数量为7.7（4.2）个，n2 - 3期患者为5.3（2.8）个（P = 0.04）。在胃周淋巴结受累局限于第1区域（P = 0.08）或第6区域（P = 0.11）的患者中也观察到了这种趋势。因此，胃周淋巴结较少的患者可能有更多淋巴管绕过胃周淋巴结并直接汇入远处淋巴结，增加了跳跃转移的可能性。阳性淋巴结数量受淋巴分布的影响程度小于阳性淋巴结的位置，应纳入分期标准。
