Impact of extranodal extension on prognosis in lymph node-positive gastric cancer
Impact of extranodal extension on prognosis in lymph node-positive gastric cancer
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DOI：
10.1002/bjs.9640
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发表时间：
2014-11-01
影响因子：
9.6
通讯作者：
Kim, B-S
中科院分区：
文献类型：
--
作者：
Lee, I-S;Park, Y-S;Kim, B-S
背景：TNM分期系统被广泛用于肿瘤分期，并指导癌症患者的治疗和预后。本研究的目的是评估结外淋巴结转移（ENE）在早期胃癌患者中的预后价值。方法：回顾性分析2003年1月至2006年6月间所有因原发性胃癌伴淋巴结转移而接受胃切除术和淋巴结清扫术的患者。转移性淋巴结的组织学切片由两名胃肠道病理学家审查。评估ENE与临床病理特征的相关性。采用Kaplan-Meier法计算疾病特异性生存率，并采用多因素考克斯回归模型确定独立预后因素。ENE与晚期pT和pN分类、较大的肿瘤大小和淋巴血管/神经周围浸润相关。多因素分析显示，pT分期、pN分期、ENE、淋巴管浸润和神经周围浸润是影响胃癌预后的独立因素。ENE患者的5年生存率为48.1%，而非ENE患者的5年生存率为78.2%（P < 0.001）。在早期胃癌患者亚组中，ENE与早期（T1）胃癌患者的5年生存率相关：ENE患者的5年生存率为75%，而无ENE患者的5年生存率为96.9%（P < 0.001）。
Background: The TNM classification system is used widely for tumour staging, and directs the treatment and prognosis of patients with cancer. The aim of this study was to assess the prognostic value of extranodal extension (ENE) in patients with early gastric cancer.Methods: All patients who underwent gastrectomy with lymphadenectomy for primary gastric cancer with lymph node metastases between January 2003 and June 2006 were reviewed. Histological slides of metastatic nodes were reviewed by two gastrointestinal pathologists. The association of ENE with clinicopathological characteristics was assessed. The disease-specific survival rate was calculated by the Kaplan-Meier method, and a multivariable Cox regression model was used to identify independent prognostic factors.Results: Some 1143 patients were included. ENE was associated with advanced pT and pN category, larger tumour size and lymphovascular/perineural invasion. In multivariable analysis, pT category, pN category, ENE, lymphovascular invasion and perineural invasion were found to be independent prognostic factors in node-positive gastric carcinoma. The 5-year survival rate of patients with ENE was 48.1 per cent, compared with 78.2 per cent for patients without ENE (P < 0.001). In the subgroup of patients with early gastric cancer, ENE was associated with a worse 5-year survival rate in patients with early (T1) gastric cancer: 75 per cent in patients with ENE versus 96.9 per cent in those without (P < 0.001).Conclusion: ENE is an independent prognostic factor in patients with early and advanced gastric cancer.