Extranodal metastasis is an indicator of poor prognosis in patients with gastric carcinoma
Extranodal metastasis is an indicator of poor prognosis in patients with gastric carcinoma
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DOI：
10.1002/bjs.5240
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发表时间：
2006-03-01
影响因子：
9.6
通讯作者：
Shimoda, T
中科院分区：
文献类型：
--
作者：
Etoh, T;Sasako, M;Shimoda, T
背景：本研究的目的是确定胃癌结外转移（EM）的临床意义和预后影响。方法：该研究纳入了 1993 年 1 月至 1996 年 12 月期间因原发性胃癌接受胃切除术和淋巴结清扫术的 1023 例患者。EM 的定义是在与原发灶或局部淋巴结不连续的壁外软组织中存在肿瘤细胞。结果：检测到 EM 1023 名患者中的 146 个（14(.)3%）以及从脂肪结缔组织中作为“淋巴结”取出的 35 811 个结节中的 1060 个（3(.)0%）存在这种情况。肿瘤较大（直径10cm以上）、浸润性、深部浸润或未分化的患者，以及有淋巴结、腹膜或肝转移、淋巴管或血管受累的患者，EM的发生率明显较高。根治性手术后，患有 EM 的患者总体生存率明显低于未患有 EM 的患者 (P < 0(.)001)。多变量分析确定 EM 是一个独立的预后因素（风险比 1(.)82（95% 置信区间 1(.)23 至 2(.)71）；P = 0(.)003）。结论：EM 是一个独立的预后因素，因此应纳入肿瘤淋巴结转移 (TNM) 分期系统。
Background: The aim of this study was to determine the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma.Methods: The study included 1023 patients who underwent gastrectomy with lymphadenectomy for primary gastric carcinoma between January 1993 and December 1996. EM was defined as the presence of tumour cells in extramural soft tissue that was discontinuous with either the primary lesion or locoregional lymph nodes.Results: EM was detected in 146 (14(.)3 per cent) of the 1023 patients and in 1060 (3(.)0 per cent) of the 35 811 nodules that were retrieved as ' lymph nodes ' from adipose connective tissues. The incidence of EM was significantly higher in patients with tumours that were large (diameter 10 cm or more), infiltrative, deeply invading or undifferentiated and in those with lymph node, peritoneal or liver metastases, or lymphatic or vascular involvement. After curative operation overall survival was significantly worse for patients with EM than those without (P < 0(.)001). Multivariate analysis identified EM as an independent prognostic factor (hazard ratio 1(.)82 (95 per cent confidence interval 1(.)23 to 2(.)71); P = 0(.)003).Conclusion: EM is an independent prognostic factor and should therefore be included in the tumour node metastasis (TNM) staging system.