Does a Higher Cutoff Value of Lymph Node Retrieval Substantially Improve Survival in Patients With Advanced Gastric Cancer?-Time to Embrace a New Digit
Does a Higher Cutoff Value of Lymph Node Retrieval Substantially Improve Survival in Patients With Advanced Gastric Cancer?-Time to Embrace a New Digit
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DOI：
10.1634/theoncologist.2016-0239
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发表时间：
2017-01-01
期刊：
影响因子：
5.8
通讯作者：
Yeh, Ta-Sen
中科院分区：
文献类型：
--
作者：
Liu, Yu-Yin;Fang, Wen-Liang;Yeh, Ta-Sen
背景本研究评估了> 25个淋巴结（LN）的回收对晚期胃癌患者根治性胃切除术后生存结局的影响。研究共纳入了1994年至2011年期间接受根治性胃切除术的5，386例胃癌患者。根据检查的淋巴结数量（25例，n = 3，012）分析临床病理参数和总生存期（OS）。从1994年到2011年，取出> 25枚淋巴结的患者百分比增加。LN > 25组患者更有可能接受全胃切除术，肿瘤体积更大，肿瘤分化程度更差，T和N分期更高。LN 25组的住院死亡率分别为6.1%、2.7%和1.7%（p <0.0001）。当OS根据肿瘤分期分层时，LN > 25组始终表现出最有利的OS，特别是对于II期疾病（p = 0.011）。同样，LN > 25组在所有淋巴结分期（从N1到N3b）中的OS显著更好。LN 25组的淋巴结比率（LNR）的区分能力分别为483、766和1，560。多因素分析显示，在LN > 25组中，LNR是影响预后的最重要因素。在根治性胃切除术中取出25个以上的淋巴结可显著提高晚期胃癌的生存率和生存分层，而不影响患者的安全性：D2淋巴结（LN）清扫是目前胃癌外科治疗的标准，很少由第三方审核。本研究是世界上最大的手术系列之一，表明传统上公认的根治性胃切除术中取出≥ 16个淋巴结可能不足以治疗局部晚期胃癌占主导地位的区域。所提供的数据表明，回收> 25个LN（更大程度上模拟D2夹层）可改善长期结局和生存分层，而不会影响患者安全性。
Background. The present study assessed the impact of the retrieval of > 25 lymph nodes (LNs) on the survival outcome of patients with advanced gastric cancer after curative-intent gastrectomy.Patients and Methods. A total of 5,386 patients who had undergone curative gastrectomy for gastric cancer from 1994 to 2011 were enrolled. The clinicopathological parameters and overall survival (OS) were analyzed according to the number of LNs examined ( 25, n = 3,012).Results. The percentage of patients with > 25 LNs retrieved increased from 1994 to 2011. Patients in the LN > 25 group were more likely to have undergone total gastrectomy and to have a larger tumor size, poorer tumor differentiation, and advanced T and N stages. Hospital mortality among the LN 25 groups was 6.1%, 2.7%, and 1.7%, respectively (p < .0001). The LN > 25 group consistently exhibited the most favorable OS, in particular, with stage II disease (p = .011) when OS was stratified according to tumor stage. Similarly, the LN > 25 group had significantly better OS in all nodal stages (from N1 to N3b). The discrimination power of the lymph node ratio (LNR) for the LN 25 groups was 483, 766, and 1,560, respectively. Multivariate analysis demonstrated that the LNR was the most important prognostic factor in the LN > 25 group.Conclusion. Retrieving more than 25 lymph nodes during curative-intent gastrectomy substantially improved survival and survival stratification of advanced gastric cancer without compromising patient safety.Implications for Practice: D2 lymph node (LN) dissection is currently the standard of surgical management of gastric cancer, which is rarely audited by a third party. The present study, one of the largest surgical series worldwide, has shown that the traditionally recognized retrieval of >= 16 LNs during curative-intent gastrectomy might not be adequate in regions in which locally advanced gastric cancers predominate. The presented data show that retrieval of > 25 LNs, which more greatly mimics D2 dissection, improves long-term outcomes and survival stratification without compromising patient safety.