淋巴结清扫总数和阴性淋巴结数对根治性远端胃大部切除胃癌患者预后的影响

目的 探讨淋巴结清扫总数和阴性淋巴结数目对根治性远端胃大部切除胃癌患者预后的影响.方法 1995年1月至2004年11月,对634例胃癌患者施行根治性远端胃大部切除手术(R0切除).分析淋巴结清扫总数与阴性淋巴结数目的相关性;对预后因素进行单因素及多因素分析;分析淋巴结清扫总数、阴性淋巴结数目与术后5年生存率的关系.结果 本组591例(93.2%)获得随访,时间5～14年,其中位生存期为62.0个月,术后5年生存率为57.6%.淋巴结清扫总数与阴性淋巴结数目的相关性具有统计学意义(P＜0.05).肿瘤浸润深度、阳性及阴性淋巴结数目和淋巴结清扫总数是影响本组患者预后的独立因素.相同TNM分期中,患者的术后5年生存率有随淋巴结清扫总数和阴性淋巴结数目增加而增高的趋势且具有统计学意义(P＜0.05).线性回归预测,淋巴结清扫总数每增加l0枚,患者术后5年生存率都有不同程度的提高:全组为13.1%、Ⅰ期为14.2%、Ⅱ期为20.5%、Ⅲ期为17.5%和Ⅳ期为10.9%;而每多清扫10枚阴性淋巴结,患者术后5年生存率亦可提高:全组为19.2%、Ⅰ期为20.1%、Ⅱ期为18.8%、Ⅲ期为18.4%和Ⅳ期为18.0%.结论 淋巴结清扫总数和阴性淋巴结数目可反映胃癌淋巴结清扫的程度并预测患者预后,应努力增加根治性远端胃大部切除胃癌患者的淋巴结清扫总数和阴性淋巴结数目,以提高远期疗效.

Prognostic impact of the number of all dissected and negative lymph nodes in gastric cancer after curative distal gastrectomy

Objective To investigate the prognostic impacts of number of all dissected and negative lymph nodes (LNs) in gastric cancer after curative distal gastrectomy. Methods This study involved 634 patients with gastric cancer, who underwent curative resection with distal gastrectomy from January 1995 to November 2004. Long-term surgical outcomes and associations between dissected LN counts or negative LN counts with the 5-year survival rate were investigated. Results In this group, 591 patients (93. 2% ) was followed-up for 5-14 years, the median survival was 62.0 months. The 5-year survival of the entire cohort was 57. 6%. The number of negative LNs was positively correlated with the retrieved nodes count on the Pearson's correlation test (P < 0. 05). Cox regression analysis showed that depth of tumor invasion, LN involvement, negative LN count and dissected LN count were independent predictors of survival (P < 0. 05). Among patients with comparable TNM ranks, the overall survival rate was significantly different among patients with different dissected LN counts or negative LN counts. For each 10 extra LNs added to the total LN count, the calculated overall survival rate increased by: 14.2% (stage Ⅰ), 20.5% (stage Ⅱ ), 17.5% (stage Ⅲ), 10.9% (stage Ⅳ) and 13. 1% (entire cohort). While, for each 10 extra negative LNs added to negative LN counts, the overall survival rate increased by: 20. 1% (stage Ⅰ ) , 18. 8% (stage Ⅱ ) , 18. 4% (stage Ⅲ) , 18. 0% (stage Ⅳ) and 19. 2% (entire cohort). Conclusions The number of dissected LNs and negative LNs are independent predictors of survival for gastric cancer. More LNs should be resected in patients receiving curative distal gastrectomy to improve prognosis.