淋巴结清扫范围对进展期胃癌患者预后的影响研究
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摘要
目的探讨不同淋巴结清扫方案对进展期胃癌患者预后的影响。方法选取267例进展期胃癌患者,所有患者均接受D1或D2淋巴结清扫术。分析淋巴结转移与进展期胃癌患者临床特征的关系,并对不同淋巴结清扫术后胃癌患者的生存情况进行分析。结果不同性别、年龄、肿瘤部位进展期胃癌患者的淋巴结转移率比较,差异均无统计学意义(P>0.05);不同肿瘤最大径、Borrmann分型、TNM分期、分化程度进展期胃癌患者的淋巴结转移率比较,差异均有统计学意义(P<0.05)。行D2淋巴结清扫术的进展期胃癌患者的中位生存时间为55.0个月(95%CI:51.1～58.9),明显长于行D1淋巴结清扫术患者的28.5个月(95%CI:21.3～34.7)(P<0.01)。结论肿瘤最大径、Borrmann分型、TNM分期及分化程度可能影响进展期胃癌患者的淋巴结转移情况,而D2淋巴结清扫术后进展期胃癌患者能获得更长的生存期。
Objective To investigate the effect of lymph node dissection range on the prognosis of patients with advanced gastric cancer. Method 267 patients with advanced gastric cancer were selected, and all patients were administered with D1 or D2 lymph node dissection. The association between clinical characteristics and lymph node metastasis was analyzed, and the survival of these patients after lymph node dissection were evaluated. Result The rates of lymph node metastasis among gastric cancer patients of different gender, age and tumor location were of no statistically significant difference(P>0.05); while the maximum diameter, Borrmann subtype, TNM stage and degree of differentiation were associated with the rate of lymph node metastasis(P<0.05). The median survival time after D2 lymph node dissection was 55.0 months(95% CI: 51.1-58.9), which was significantly longer than the 28.5 months(95% CI: 21.3-34.7) after D1 lymph node dissection(P<0.01). Conclusion In advanced gastric cancer, maximum tumor diameter, Borrmann subtype,TNM stage and degree of differentiation can significantly affect the rate of lymph node metastasis, furthermore, D2 lymph node dissection may prolong the survival of patients with advanced gastric cancer.
Objective To investigate the effect of lymph node dissection range on the prognosis of patients with advanced gastric cancer. Method 267 patients with advanced gastric cancer were selected, and all patients were administered with D1 or D2 lymph node dissection. The association between clinical characteristics and lymph node metastasis was analyzed, and the survival of these patients after lymph node dissection were evaluated. Result The rates of lymph node metastasis among gastric cancer patients of different gender, age and tumor location were of no statistically significant difference(P>0.05); while the maximum diameter, Borrmann subtype, TNM stage and degree of differentiation were associated with the rate of lymph node metastasis(P<0.05). The median survival time after D2 lymph node dissection was 55.0 months(95% CI: 51.1-58.9), which was significantly longer than the 28.5 months(95% CI: 21.3-34.7) after D1 lymph node dissection(P<0.01). Conclusion In advanced gastric cancer, maximum tumor diameter, Borrmann subtype,TNM stage and degree of differentiation can significantly affect the rate of lymph node metastasis, furthermore, D2 lymph node dissection may prolong the survival of patients with advanced gastric cancer.
引文
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[17]Kaise M.Advanced endoscopic imaging for early gastric cancer[J].Best Pract Res Clin Gastroenterol,2015,29(4):575-587.
[2]Goetze OT,Al-Batran SE,Chevallay M,et al.Multimodal treatment in locally advanced gastric cancer[J].Updates in Surgery,2018,70(2):173-179.
[3]Yu X,Hu F,Li C,et al.Clinicopathologic characteristics and prognosis of proximal and distal gastric cancer[J].Onco Targets Ther,2018,11:1037-1044.
[4]Feng F,Zheng G,Guo X,et al.Impact of body mass index on surgical outcomes of gastric cancer[J].BMC Cancer,2018,18(1):151.
[5]Ren L,Zhao Z,Luo Y,et al.Pathological characteristics and prognostic factors of advanced gastric cancer[J].J Mod Med Health,2017 33(16):2454-2456.
[6]Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2010(ver.3)[J].Gastric Cancer,2011,14(2):113-123.
[7]Ilhan E,Ureyen O,Meral UM.Ongoing problems concerning 7thTNM staging system and proposals for 8thTNM staging system of gastric cancer[J].Przegla?d Gastroenterologiczny,2016,11(4):223-225.
[8]Jin H,Sun J,Zhu K,et al.The prognostic value of neutrophil-lymphocyte ratio is superior to derived neutrophillymphocyte ratio in advanced gastric cancer treated with preoperative chemotherapy and sequential R0 resection:a 5-year follow-up[J].Onco Targets Ther,2017,10:2655-2664.
[9]ObermannováR,Lordick F.Insights into next developments in advanced gastric cancer[J].Curr Opin Oncol,2016,28(4):367-375.
[10]陈元岩,陈显国,李天翔,等.进展期胃癌淋巴结转移规律与清扫范围对临床结局的影响[J].广东医学,2016,37(24):3693-3695.
[11]Liang,Deng J.Evaluation of rational extent lymphadenectomy for local advanced gastric cancer[J].Chin J Cancer Res,2016,28(4):397-403.
[12]Qi X,Liu Y,Wang W,et al.Management of advanced gastric cancer:an overview of major findings from meta-analysis[J].Oncotarget,2016,7(47):78180-78205.
[13]Morita S,Fukagawa T,Fujiwara H,et al.The clinical significance of para-aortic nodal dissection for advanced gastric cancer[J].Eur J Surg Oncol,2016,42(9):1448-1454.
[14]Davidson M,Okines AF,Starling N.Current and future therapies for advanced gastric cancer[J].Clin Colorectal Cancer,2015,14(4):239-250.
[15]Bonenkamp JJ,Hermans J,Sasako M,et al.Extended lymphnode dissection for gastric cancer.Dutch gastric cancer group[J].N Engl J Med,1999,340(12):908-914.
[16]Cuschieri A,Weeden S,Fielding J,et al.Patient survival after D1 and D2 resections for gastric cancer:long-term results of the MRC randomised surgical trial.Surgical cooperative group[J].Br J Cancer,1999,79(9-10):1522-1530.
[17]Kaise M.Advanced endoscopic imaging for early gastric cancer[J].Best Pract Res Clin Gastroenterol,2015,29(4):575-587.
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