远端胃癌淋巴结转移规律及临床意义
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摘要
目的:探讨远端胃癌各组淋巴结转移的特点,指导远端胃癌根治手术中淋巴结清扫的范围。方法:回顾性分析2010年2月至2014年9月天津医科大学肿瘤医院远端胃癌患者773例接受D2(D2+)胃次全切除术的临床病理资料,分析其淋巴结转移特点。结果:773例远端胃癌患者术后病理证实淋巴结转移为423例(54.72%),各组淋巴结中发生转移的患者所占比例由高至低依次为NO.6、NO.3、NO.4sb、NO.5组淋巴结。N1淋巴结转移率由高至低依次为NO.3、NO.6、NO.5、NO.4d组淋巴结;N2淋巴结转移率由高至低依次为NO.8a、NO.7、NO.1组淋巴结。50.68%的患者出现NO.8a组淋巴结跳跃性转移。结论:远端胃癌根治性手术应注意NO.8a淋巴结转移的可能性,必要时应适当扩大淋巴结的清扫范围。
Objective:The characteristics of lymph node metastasis were investigated to guide the range of lymph node dissection during the radical operation of distal gastric cancer.Methods:The clinical data of 773 patients with distal gastric cancer who underwent radical distal subtotal gastrectomy at the Tianjin Medical University Cancer Institute and Hospital between February 2010 and September 2014 were reviewed and analyzed to infer the potential clinical mechanisms of lymph node metastasis.Results:Among the included patients,423(54.72%) had lymph node metastasis.The proportion of metastasis in the patients from the highest to the lowest rate was observed in group NO.6,3,4sb,and 5 lymph nodes.The metastasis rates of the N1 lymph nodes from the highest to the lowest were observed in group NO.3,6,5,and 4d lymph nodes,whereas those of the N2 lymph nodes occurred in group NO.8a,7,and 1lymph nodes.Group NO.8a lymph node with skipped metastasis was observed in 50.68% of the patients.Conclusion:During radical distal gastric cancer surgery,attention should be given to the possibility of metastasis in group NO.8a lymph node.Appropriate extension of the lymph node dissection should be conducted when necessary.
Objective:The characteristics of lymph node metastasis were investigated to guide the range of lymph node dissection during the radical operation of distal gastric cancer.Methods:The clinical data of 773 patients with distal gastric cancer who underwent radical distal subtotal gastrectomy at the Tianjin Medical University Cancer Institute and Hospital between February 2010 and September 2014 were reviewed and analyzed to infer the potential clinical mechanisms of lymph node metastasis.Results:Among the included patients,423(54.72%) had lymph node metastasis.The proportion of metastasis in the patients from the highest to the lowest rate was observed in group NO.6,3,4sb,and 5 lymph nodes.The metastasis rates of the N1 lymph nodes from the highest to the lowest were observed in group NO.3,6,5,and 4d lymph nodes,whereas those of the N2 lymph nodes occurred in group NO.8a,7,and 1lymph nodes.Group NO.8a lymph node with skipped metastasis was observed in 50.68% of the patients.Conclusion:During radical distal gastric cancer surgery,attention should be given to the possibility of metastasis in group NO.8a lymph node.Appropriate extension of the lymph node dissection should be conducted when necessary.
引文
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[16]Kim DH,Choi MG,Noh JH,et al.Clinical significance of skip lymph node metastasis in gastric cancer patients[J].Eur J Surg Oncol,2015,41(3):339-345.
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[2]Sasako M,Sano T,Yamamoto S,et al.D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer[J].N Engl J Med,2008,359(5):453-462.
[3]Du FG,Wen G.Research progress of lymph node dissection[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(3):695-697.[杜方超,文刚.胃癌淋巴结清扫的研究进展[J].中华临床医师杂志(电子版),2012,6(3):695-697.]
[4]Japanese Gastric Cancer Association.Japanese Classification of Gastric Carcinoma-2nd English Edition[J].Gastric Cancer,1998,1(1):10-24.
[5]Santiago JM,Sasako M,Osorio J.TNM-7th edition 2009(UICC/AJCC)and Japanese Classification 2010 in Gastric Cancer.Towards simplicity and standardisation in the management of gastric cancer[J].Cir Esp,2011,89(5):275-281.
[6]Chinese Ministry of Health,Medical Administration.Diagnostic and treatment practices of Gastric cancer(2011 edition)[J].Chinese Journal of the Frontiers of Medical Science(Electronic Version),2012,4(5):62-71.[中华人民共和国卫生部医政司.胃癌诊疗规范(2011年版)[J].中国医学前沿杂志(电子版),2012,4(5):62-71.]
[7]Cho YK,Chung JW,Kim JK,et al.Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization[J].Cancer,2008,112(2):352-361.
[8]Tanizawa Y,Terashima M.Lymph node dissection in the resection of gastric cancer:review of existing evidence[J].Gastric Cancer,2010,13(3):137-148.
[9]Zhang M,Zhu G,Ma Y,et al.Comparison of four staging systems of lymph node metastasis in gastric cancer[J].World J Surg,2009,33(11):2383-2388.
[10]Deng JY.Current clinical research on nodal metastasis from gastric cancer[J].Chin J Clin Oncol,2013,40(22):1370-1372.[邓靖宇.淋巴结转移在胃癌临床研究中的现况[J].中国肿瘤临床,2013,40(22):1370-1372.]
[11]Zeng CQ,Liu JS,Zheng Y,et al.Discussion of lymph node metastasis and dissection methods with distal gastric cancer[J].Chinese Journal of Gastrointestinal Surgery,2012,15(2):141-144.[曾长青,刘进生,郑羽,等.远端胃癌淋巴结转移规律与淋巴结清扫方式的探讨[J].中华胃肠外科杂志,2012,15(2):141-144.]
[12]Han KB,Jang YJ,Kim JH,et al.Clinical significance of the pattern of lymph node metastasis depending on the location of gastric cancer[J].J Gastric Cancer,2011,11(2):86-93.
[13]Shida A,Fujioka S,Kawamura M,et al.Prediction of lymph node metastasis in patients with submucosa-invading early gastric cancer[J].Anticancer Res,2014,34(8):4471-4474.
[14]Zhan WH,Han FH.Current Status and Evaluation of Abdominal Paraaortic Lymph Node Dissection on Gastric Carcinoma[J].Chinese Journal of Bases and Clinics in General Surgery,2006,13(1):4-6.[詹文华,韩方海.胃癌腹主动脉周围淋巴结清扫现状与评价[J].中国普外基础与临床杂志,2006,13(1):4-6.]
[15]Deng JY,Liang H.Clinical significance of lymph node metastasis in gastric cancer[J].World J Gastroenterol,2014,20(14):3967-3975.
[16]Kim DH,Choi MG,Noh JH,et al.Clinical significance of skip lymph node metastasis in gastric cancer patients[J].Eur J Surg Oncol,2015,41(3):339-345.
[17]Takashima S,Kosaka T.Results and controversial issues regarding a para-aortic lymph node dissection for advanced gastric cancer[J].Surg Today,2005,35(6):425-431.