Analysis of the Lymphatic Stream to Predict Sentinel Nodes in Gastric Cancer Patients
Analysis of the Lymphatic Stream to Predict Sentinel Nodes in Gastric Cancer Patients
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DOI：
10.1245/s10434-013-3392-9
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发表时间：
2014-04-01
影响因子：
3.7
通讯作者：
Yang, Han-Kwang
中科院分区：
文献类型：
--
作者：
Lee, Ju-Hee;Lee, Hyuk-Joon;Yang, Han-Kwang
目的.探讨胃癌患者淋巴引流的模式，根据肿瘤部位预测前哨淋巴结的位置。研究共纳入了462例转移至1-3个淋巴结（LN）的pT 1或T2胃腺癌患者，这些患者接受了大于D1+ β的淋巴结切除术。转移淋巴结的分布根据肿瘤的纵向和周向位置进行评估。分析非典型转移（跳跃转移或横向转移）的发生率及相关临床病理因素。跳跃转移率为15.8%（73/462），横向转移率为10.3%（23/224）.无论肿瘤位置如何，均观察到非典型转移。显示最常见的非典型转移的肿瘤位于胃的下三分之一和胃小弯（LC）（跳跃转移29.0%，横向转移18.0%）。在单因素和多因素分析中，LC肿瘤是跳跃式转移的危险因素，肿瘤位于LC周向或纵向位于胃的下三分之一是横向转移的独立危险因素。肿瘤侵袭性与不典型转移无相关性。任何位置的肿瘤都有发生非典型转移的可能性;然而，与其他位置相比，纵向位于LC下部或周向位于LC的肿瘤发生非典型转移的可能性显著更高。当应用前哨淋巴结导航手术时，应特别注意这些位置的肿瘤，以防止假阴性结果。
Purpose. To investigate the pattern of lymphatic drainage in gastric cancer patients to predict sentinel node placement according to tumor location.Methods. A total of 462 pT1 or T2 gastric adenocarcinoma patients with metastasis to 1-3 lymph nodes (LNs) who had undergone lymphadenectomy greater than D1+beta were included in the study. The distribution of metastatic LNs was evaluated according to tumor longitudinal and circumferential location. The incidence rate of atypical metastasis (skip or transversal metastasis) and related clinicopathologic factors were analyzed.Results. The rates of skip and transversal metastasis were 15.8 % (73 of 462) and 10.3 % (23 of 224), respectively. Atypical metastasis was observed regardless of tumor location. Tumors that showed the most frequent atypical metastasis were located in the lower third and lesser curvature (LC) of the stomach (29.0 % for skip metastasis and 18.0 % for transversal metastasis). In uni-and multivariate analyses, an LC tumor was a risk factor for skip metastasis, and tumor located circumferentially in the LC or longitudinally in the lower third of the stomach was an independent risk factor for transversal metastasis. There was no correlation between tumor aggressiveness and atypical metastasis.Conclusions. Tumors at any location had a chance of atypical metastasis; however, those located longitudinally in the lower or circumferentially at the LC had a significantly higher chance of atypical metastasis compared to other locations. When sentinel node navigation surgery is applied, special care should be taken with tumors at these locations to prevent false-negative results.