Clinical significance of accurate identification of lymph node status in distant metastatic gastric cancer.
Clinical significance of accurate identification of lymph node status in distant metastatic gastric cancer.
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准确识别远处转移性胃癌淋巴结状态的临床意义
DOI：
10.18632/oncotarget.6009
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发表时间：
2016-01-05
期刊：
影响因子：
--
通讯作者：
Liao W
中科院分区：
文献类型：
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作者：
Zhou R;Wu Z;Zhang J;Wang H;Su Y;Huang N;Shi M;Bin J;Liao Y;Liao W
准确识别远端转移性胃癌（DMGC）淋巴结（LN）状态的临床结果尚不清楚。我们的目的是确定N分期、阳性LN（PLN）计数和阳性LN比率（LNR）的预后意义。我们还回顾性比较了按LN夹层（LND）分层的DMGC患者的生存结局。结果1593例患者行LND。在接受LND的DMGC患者中，根据N分期、PLN和LNR分组的CSS差异有统计学意义。较低的LNR是所有患者队列中较长生存期的独立预测因子，而PLN不是这样的预测因子。PLN计数与LND数和LNR相关。LNR与LND数无相关性。接受LND和有较多数量的LNs与上级CSS相关。材料与方法回顾了2004年至2009年期间接受治疗的1889例DMGC患者的数据，并记录在监测、流行病学和最终结果（SEER）登记处。用Pearson相关系数和卡方检验研究了LND数、PLN数、N期与LNR的关系。采用Kaplan-Meier分析评价癌症特异性生存期（CSS），单变量分析（UVA）采用对数秩检验，多变量分析（MVA）采用考克斯比例风险模型。结论LN转移变量对DMGC患者的预后评估和治疗决策具有重要意义。准确识别DMGC患者的LN状态至关重要。LND性能与生存率增加相关，具有临床实用性。
PURPOSE The clinical consequences of accurately identifying lymph node (LN) status in distant metastatic gastric cancer (DMGC) are unclear. We aimed to determine the prognostic significance of N stage, positive LN (PLN) count, and the positive LN ratio (LNR). We also retrospectively compared survival outcomes of DMGC patients stratified by LN dissection (LND). RESULTS LND was performed in 1593 patients. The CSS was significantly different between groups divided according to N stage, PLN, and LNR in DMGC patients who underwent LND. Lower LNR was an independent predictor of longer survival in all kinds of patients cohorts, whereas PLN was not such a predictor. PLN count correlated with LND number and LNR. No correlation existed between LNR and LND number. Undergoing LND and having a higher number of dissected LNs were associated with superior CSS. MATERIALS AND METHODS Data from 1889 DMGC patients treated between 2004 and 2009, and documented in the Surveillance, Epidemiology, and End Results (SEER) registry, were reviewed. Pearson's correlation coefficient and the Chi-square test were used to study the relationships between LND number, PLN count, N stage, and the LNR. Cancer-specific survival (CSS) was evaluated using Kaplan-Meier analysis, with the log-rank test performed for univariate analysis (UVA) and the Cox proportional hazards model employed for multivariate analysis (MVA). CONCLUSION LN metastatic variables play important roles in the prognostic evaluation and treatment decisions of DMGC patients. Accurate identification of LN status in DMGC patients is critical. LND performance is associated with increased survival and has clinical practicability.