Clinical significance of skip lymph-node metastasis in pN1 gastric-cancer patients after curative surgery
Clinical significance of skip lymph-node metastasis in pN1 gastric-cancer patients after curative surgery
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DOI：
10.1093/gastro/goz008
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发表时间：
2019-06-01
影响因子：
3.6
通讯作者：
Liang, Han
中科院分区：
文献类型：
--
作者：
Liu, Jin-Yuan;Deng, Jing-Yu;Liang, Han
背景：跳跃性淋巴结转移(SLNM)是一种低发率的胃癌转移方式，除原发灶外，跳跃性淋巴结转移(SLNM)是胃癌的一种低发转移方式。到目前为止，SLNM的机制和转归还没有完全阐明。方法：对505例有淋巴结转移的胃癌患者的临床病理资料及随访资料进行分析，探讨SLNM在评估预后中的意义。结果：505例有淋巴结转移的胃癌患者中，24例(4.8%)经病理证实为SLNM。淋巴结转移部位与5年生存率和总生存率无明显相关性(P=0.194)。分层生存分析结果显示，在PN1GC患者中，SLNM状态与OS显著相关(P=0.001)。19例PN1GC伴SLNM患者的中位OS明显短于100例有胃周淋巴结转移的患者(P<；0.001)。病例对照配对Logistic回归分析结果显示，肿瘤大小(P=0.002)是预测PN1GC根治性手术后SLNM的唯一临床病理因素。在19例PN1 GC患者中，有17例(89.5%)有肝总动脉、腹主动脉周围或肝十二指肠韧带的淋巴结转移。结论：SLNM可作为预测PN1 GC各亚型预后的指标。
Background: In addition to the stepwise manner of lymph-node metastasis from the primary tumour, the skip lymph-node metastasis (SLNM) was identified as a low-incidence metastasis of gastric cancer (GC). So far, both the mechanism and outcome of SLNM have not been elucidated completely. The purpose of this study was to analyse the clinical significance and the potential mechanism of SLNM in GC patients who had lymph-node metastasis.Methods: Clinicopathological data and follow-up information of 505 GC patients who had lymph-node metastasis were analysed to demonstrate the significance of SLNM in evaluating the prognostic outcome. According to the pathological results, all GC patients who had lymph-node metastasis were categorized into three groups: patients with the perigastric lymph-node metastasis, patients with the perigastric and extragastric lymph-node metastasis and patients with SLNM.Results: Among the 505 GC patients who had lymph-node metastasis, 24 (4.8%) had pathologically identified SLNM. The location of lymph-node metastasis was not significantly associated with 5-year survival rate and overall survival (OS) (P = 0.194). The stratified survival analysis results showed that the status of SLNM was significantly associated with the OS in patients with pN1 GC (P = 0.001). The median OS was significantly shorter in 19 pN1 GC patients with SLNM than in 100 patients with perigastric lymph-node metastasis (P< 0.001). The case-control matched logistic regression analysis results showed that tumour size (P = 0.002) was the only clinicopathological factor that may predict SLNM in pN1 GC patients undergoing curative surgery. Among the 19 pN1 GC patients with SLNM, 17 (89.5%) had metastatic lymph nodes along the common hepatic artery, around the celiac artery or in the hepatoduodenal ligament.Conclusions: SLNM may be considered a potentially practicable indicator for prognosis among various subgroups of pN1 GC patients.