Clinical impact of metastatic lymph node ratio in advanced gastric cancer.
Clinical impact of metastatic lymph node ratio in advanced gastric cancer.
复制标题
DOI：
--
复制
发表时间：
2005-03
影响因子：
2
通讯作者：
C. Kunisaki;H. Shimada;M. Nomura;G. Matsuda;Y. Otsuka;H. Ono;H. Akiyama
中科院分区：
文献类型：
--
作者：
C. Kunisaki;H. Shimada;M. Nomura;G. Matsuda;Y. Otsuka;H. Ono;H. Akiyama
背景：我们研究了根治性切除后转移淋巴结比率(转移淋巴结数目与切除数目的比率)对预后的价值。患者和方法对758例患者的手术效果进行单因素和多因素分析，将转移性淋巴结比率分为0、0.1、0.2四类。并与UICC/TNM分期进行了比较，比较了淋巴比作为淋巴结分期系统的合理性和预后意义。结果单因素分析显示，手术方式、肿瘤部位、肿瘤大体形态、肿瘤直径、侵犯深度、转移淋巴结比例、淋巴侵犯和静脉侵犯对预后有显著影响。Cox比例回归风险模型显示肿瘤大体形态、肿瘤直径、侵袭深度和转移淋巴结比率是影响预后的独立因素。在UICC/TNM分类的pn2患者中，转移性淋巴结比<0.1的患者的生存率明显好于转移性淋巴结比较高的患者。结论淋巴结转移率是影响预后的独立因素。扩大淋巴清扫术可将转移淋巴结比降至0.1以下，从而提高pn2期胃癌患者的生存率。
BACKGROUND We examined the prognostic value of metastatic lymph node ratio (the ratio of the number of metastatic lymph nodes to the number of lymph nodes removed) after curative resection. PATIENTS AND METHODS The results of surgery on 758 patients were assessed by uni-and multi-variate analysis by classifying the metastatic lymph node ratio into 4 categories: 0, 0.1 0.2. Furthermore, the rationality and prognostic significance of the lymph node ratio classification as a nodal staging system was compared with the UICC/TNM classification. RESULTS Univariate analysis showed that operative method, location of tumor, macroscopic appearance, tumor diameter, depth of invasion, metastatic lymph node ratio, lymphatic invasion and venous invasion significantly affected prognosis. A Cox proportional regression hazard model revealed that macroscopic appearance, tumor diameter, depth of invasion and metastatic lymph node ratio independently influenced prognosis. Among patients with pN2 by the UICC/TNM classification, survival in those with a metastatic lymph node ratio less than 0.1 was significantly better than in those with a higher metastatic lymph node ratio. CONCLUSIONS The metastatic lymph node ratio is an independent prognostic factor. Extended lymphadenectomy could increase survival of patients with pN2 gastric cancer by decreasing the metastatic lymph node ratio below 0.1.