| 高利雄,Xiankun Ren,Guiquan Li,Benhua Wu,Xuan Chen. Influence of lymph node micrometastasis on the staging system for gastric cance. Oncol Transl Med, 2020, 6: 266-271. |
| 淋巴结微转移是否应纳入胃癌分期标准的探讨 |
| Influence of lymph node micrometastasis on the staging system for gastric cance |
| Received:May 12, 2020 Revised:July 09, 2020 |
| DOI：10.1007/s10330-020-0429-9 |
| 中文关键词: 胃癌；淋巴结微转移；TNM分期 |
| 英文关键词: gastric cancer; lymph node micrometastasis; TNM stage |
| 基金项目: |
| Author Name | Affiliation | E-mail | | 高利雄* | Department of Gastroenterology, Medical Center Hospital of Qionglai | xiangxiangxiaohu@163.com | | Xiankun Ren | Department of Gastroenterology, Medical Center Hospital of Qionglai | | | Guiquan Li | Department of Gastroenterology, Medical Center Hospital of Qionglai | | | Benhua Wu | Department of Gastroenterology, Medical Center Hospital of Qionglai | | | Xuan Chen | Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University | |
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| 中文摘要: |
| 目的：探讨淋巴结微转移对胃癌患者预后的影响，以及纳入胃癌分期系统的必要性。方法：前瞻性收集2010年2月至2016年12月邛崃市医疗中心医院胃肠外科接受根治性切除的241名胃癌患者为研究对象。对手术切除淋巴结进行HE染色，对阴性淋巴结再进行抗细胞角蛋白抗体(CAM5.2)的免疫组化染色，检测淋巴结微转移情况。比较常规淋巴结分期系统和纳入微转移的新淋巴结分期系统下患者的生存率差异。并对淋巴结微转移的预后判断价值进行多因素分析。结果：（1）78例(32.4%)患者存在淋巴结微转移。与无微转移组比较，微转移组的总体复发率、淋巴浸润、血管侵袭、神经侵袭的发生率明显较高（P＜0.05）。（2）根据传统N分期标准，N0、N1、N2、N3a和N3b患者的3年DFS分别为96.0%、84.0%、67.6%、59.0%和21.7%。但N2期与N3a期之间无显著性差异，且N2和N3a的累积生存曲线相互交叉。（3）应用新的反映微转移的N分期系统，38例患者(15.8%)的N分期发生改变。8例患者(3.3%)经历了两个或两个以上的N期上升。N0～N3b患者的DFS分别为97.0%、86.3%、74.2%、65.4%和29.2%。N2和N3a分期之间无明显差异，但N2和N3a的累积生存曲线并不交叉。（4）Cox多因素分析发现，合并神经浸润、病理T分期、淋巴结清扫数量、淋巴结宏观转移及微转移均是影响胃癌患者复发的独立性危险因素（P＜0.05）。结论：淋巴结微转移是胃癌复发的重要危险因素。在评估TNM分期时应考虑淋巴结微转移，以确定预后和最佳治疗策略。 |
| 英文摘要: |
| Objective The aim of this study was to investigate the effect of lymph node micrometastasis on the
prognosis of patients with gastric cancer and the necessity of integrating it into the gastric cancer staging
system.
Methods In total, 241 patients with gastric cancer were included. Hematoxylin and eosin staining of
lymph nodes was performed, and negative lymph nodes were evaluated by immunohistochemistry to detect
micrometastases. Differences in survival rates between stages were evaluated.
Results (1) A total of 78 patients (32.4%) had lymph node micrometastases. Compared with the group
without micrometastases, the overall recurrence rate, lymph infiltration, vascular invasion, and nerve
invasion rate in the micrometastasis group were significantly higher (P < 0.05). (2) According to the
standard N staging system, the rates of disease-free survival (DFS) for the N0, N1, N2, N3a, and N3b
groups were 96.0%, 84.0%, 67.6%, 59.0%, and 21.7%, respectively. There was no significant difference
in survival between N2 and N3a. The cumulative survival curves for N2 and N3a intersected. (3) The
N stage of 38 patients (15.8%) differed between the traditional system and the new N staging system
reflecting micrometastasis. The DFS for N0, N1, N2, N3a, and N3b were 97.0%, 86.3%, 74.2%, 65.4%,
and 29.2%, respectively. There was no significant difference in survival between N2 and N3a, but the
cumulative survival curves for N2 and N3a did not intersect. (4) Based on a Cox multivariate analysis,
various independent risk factors for recurrence were identified (P < 0.05).
Conclusion Lymph node micrometastasis is an important risk factor for gastric cancer recurrence.
Lymph node micrometastasis should be considered in TNM staging to determine prognosis and optimal
treatment strategies. |
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