Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study
Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study
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DOI：
10.1007/s10120-012-0183-0
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发表时间：
2013-07-01
期刊：
影响因子：
7.4
通讯作者：
Doki, Yuichiro
中科院分区：
文献类型：
--
作者：
Fujitani, Kazumasa;Miyashiro, Isao;Doki, Yuichiro
根治性淋巴结切除术联合全胃切除术是否真的有助于Siewert II型贲门腺癌的长期生存仍不确定。我们确定了晚期II型腺癌腹部淋巴结转移的模式，并确定了腹部淋巴结清扫的最佳范围。从4,884例胃癌患者的数据库中确定了86例接受R 0全胃切除术的晚期II型腺癌患者。多因素分析影响预后的因素。以转移发生率乘以各站阳性淋巴结患者的5年生存率来估计各站淋巴结清扫的治疗价值，总的5年生存率为37.1%。年龄小于65岁[风险比，0.455（95%置信区间（CI），0.261-0.793）]和以pN 3为参考的淋巴结受累[pN 0的风险比，0.129（95% CI，0.048-0.344）; pN 1，0.209（95% CI，0.097-0.448）; pN 2，0.376（95% CI，0.189-0.746）]被确定为延长生存期的显著决定因素。认为位置4d-6的胃下半部分的胃周淋巴结不利于解剖，而在位置1-3和第二-3解剖胃上半部分的胃周淋巴结具有实质性的治疗益处，通过近端胃切除术获得的有限淋巴结切除术可能足以替代全胃切除术的扩大淋巴结切除术，腹部淋巴结切除术对晚期Siewert II型腺癌具有潜在的治疗益处。
It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy.Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station.The overall 5-year survival rate was 37.1 %. Age less than 65 years [hazard ratio, 0.455 (95 % confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95 % CI, 0.048-0.344); for pN1, 0.209 (95 % CI, 0.097-0.448); and for pN2, 0.376 (95 % CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11.Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.