Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: Analysis of a large European monoinstitutional experience
Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: Analysis of a large European monoinstitutional experience
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DOI：
10.1245/aso.2003.03.520
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发表时间：
2003-11-01
影响因子：
3.7
通讯作者：
Lise, M
中科院分区：
文献类型：
--
作者：
Nitti, D;Marchet, A;Lise, M
背景：鉴于对胃癌患者准确分期所需检查的淋巴结水平和数量缺乏共识，我们的目的是在欧洲单一机构的大型经验中评估淋巴结状态的预后意义。方法：对 1980 年至 2000 年的前瞻性数据库进行回顾，当时 445 例胃腺癌手术患者中有 314 例接受了 D2 淋巴结切除术根治性切除术 (R0)。通过Kaplan-Meier方法确定存活率并通过对数秩检验评估差异。使用 Cox 比例风险模型进行向前逐步回归进行多变量分析。结果：在 277 名可评估患者中，5 年生存率为 57%（中位随访时间为 48 个月；范围为 2-251）。总共检查了 7668 个淋巴结（中位数为 27 个；范围为 11-62 个）。根据转移/检查淋巴结比率（N 比率），N 比率 >25%、11%-25%、1%-10% 和 0% 的患者组的 5 年生存率分别为 14%、50%、61% 和 82%（P < .0001）。在多变量分析中，N 比是最佳的单一独立预后因素 (P = .000)。结论：胃癌 R0 切除后，N 比是一个有效的预后因素。因此，在临床决策过程中应予以考虑。
Background: In view of the lack of consensus on the level and number of lymph nodes to be examined for accurate staging of patients with gastric cancer, our aim was to evaluate the prognostic significance of lymph node status in a large European monoinstitutional experience.Methods: A review was made of our prospective database from 1980 to 2000, when 314 of 445 patients operated for gastric adenocarcinoma underwent radical resection (R0) with D2 lymphadenectomy. Survival was determined by the Kaplan-Meier method and differences were assessed by the log-rank test. Multivariate analysis was performed using the Cox proportional hazards model in forward stepwise regression.Results: In 277 evaluable patients, 5-year survival was 57% (median follow-up, 48 months; range, 2-251). A total of 7668 lymph nodes were examined (median, 27; range, 11-62). The 5-year survivals according to the metastatic/examined lymph nodes ratio (N ratio) were 14%, 50%, 61%, and 82% in the group of patients with N ratio >25%, 11%-25%, 1%-10%, and 0%, respectively (P < .0001). At multivariate analysis, the N ratio was the best single independent prognostic factor (P = .000).Conclusions: After R0 resection for gastric cancer, the N ratio is a potent prognostic factor. It should therefore be considered in the clinical decision making process.