Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer
Impact of lymphatic and/or blood vessel invasion in stage II gastric cancer
复制标题
DOI：
10.3748/wjg.v18.i27.3610
复制
发表时间：
2012-07-21
影响因子：
4.3
通讯作者：
Shi, Ying-Qiang
中科院分区：
文献类型：
--
作者：
Du, Chun-Yan;Chen, Jing-Gui;Shi, Ying-Qiang
目的：探讨淋巴和/或血管侵犯（LBVI）在胃癌II期患者中的预后价值。方法：2001年1月至2006年12月，487例经组织学证实的原发性胃腺癌患者在复旦大学上海肿瘤中心胃癌与软组织外科按照美国癌症分期联合委员会新版第七版诊断为II期胃癌。所有患者均行根治性胃切除术及标准淋巴结清扫术。51例因各种并发症或其他情况在术后死亡的患者被排除在外。分析临床病理表现及临床转归。根据LBVI和LN转移情况将患者分为四组。这四组患者在年龄、性别、肿瘤部位、pT类别、肿瘤分级和手术方式（次全切除vs全切除）方面进行了特征分析，并通过单因素和多因素分析比较了5年总生存率。结果：该研究包括320名男性和116名女性，年龄58.9 +/- 11.5岁（范围：23-88岁）。5年总生存率为50.7%，中位生存期为62个月。II期肿瘤334例，其中T3N1 268例，T3N1 63例，T1N2 3例；II期肿瘤102例，其中T3N1 49例，T2N2 51例，T1N3 1例，T4aN0 1例。胃癌ⅱ期LBVI的发生率为28.0%，ln阴性和ln阳性患者分别为19.0%（51/269）和42.5%（71/167）。在218例（50.0%）患者中，既没有组织病理学检测到LBVI，也没有淋巴结转移（LBVI-/LN-， I组）；在51例（11.7%）患者中，未检测到淋巴结转移的LBVI （LBVI+/LN-， II组）。167例患者（38.3%）发现淋巴结转移。其中96例（22.0%）患者（LBVI-/LN+， III组）未进行LBVI检测，71例（16.3%）患者（LBVI+/LN+， IV组）进行了LBVI检测。相关分析显示，N类别和阳性LNs数与LBVI存在显著相关（P < 0.001）。ln阴性患者的总5年生存率明显长于ln阳性患者（56.1% vs 42.3%, P = 0.015）。lbvi阳性肿瘤与lbvi阴性肿瘤的5年总生存率差异有统计学意义（39.6% vs 54.8%, P = 0.006）。两组患者5年总生存率分别为58.8%（ⅰ）、45.8%（ⅱ）、45.7%（ⅲ）、36.9%（ⅳ），四组患者总生存率差异有统计学意义（P = 0.009）。对II期胃癌患者的多因素分析显示，LBVI对ln阴性患者的预后有独立影响（P = 0.018），对ln阳性患者无独立影响（P = 0.508）。结论：在ln阴性的II期胃癌患者中，LBVI是另一个独立的预后指标，可能为鉴别预后较差的患者提供有用的信息。(c) 2012年白石登。版权所有。
AIM: To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage II gastric cancer.METHODS: From January 2001 to December 2006, 487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage II gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node (LN) dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathological findings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure (subtotal resection vs total resection), and compared for 5-year overall survival by univariate and multivariate analysis.RESULTS: The study was composed of 320 men and 116 women aged 58.9 +/- 11.5 years (range: 23-88 years). The 5-year overall survival rates were 50.7% and the median survival time was 62 mo. Stage II a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three T1N2, and stage II b was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one T1N3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% (51/269) and 42.5% (71/167) in LN-negative and LN-positive patients, respectively. In 218 patients (50.0%), there was neither a histopathologically detectable LBVI nor LN metastases (LBVI-/LN-, group I); in 51 patients (11.7%), LBVI with no evidence of LN metastases was detected (LBVI+/LN-, group II). In 167 patients (38.3%), LN metastases were found. Among those patients, LBVI was not determined in 96 patients (22.0%) (LBVI-/LN+, group III), and was determined in 71 patients (16.3%) (LBVI+/LN+, group IV). Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P < 0.001). The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1% vs 42.3%, P = 0.015). There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI-negative tumors (39.6% vs 54.8%, P = 0.006). Overall 5-year survival rates in each group were 58.8% (I), 45.8% (II), 45.7% (III) and 36.9% (IV), and there was a significant difference in overall survival between the four groups (P = 0.009). Multivariate analysis in stage II gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negative patients (P = 0.018) but not in LN-positive patients (P = 0.508).CONCLUSION: In LN-negative stage II gastric cancer patients, LBVI is an additional independent prognostic marker, and may provide useful information to identify patients with poorer prognosis. (c) 2012 Baishideng. All rights reserved.