727例胃癌根治术标本淋巴结精细分拣的临床价值探讨

目的:探讨胃癌根治术标本中淋巴结精细分拣的临床应用价值。方法:回顾性分析2016年1月至2017年12月就诊于天津医科大学肿瘤医院实施胃癌根治术的727例胃癌患者临床病理资料,按照手术切除标本中淋巴结分拣方式分为精细淋巴结分拣组和区域淋巴结分拣组,分析两组患者送检淋巴结数目、转移淋巴结数目的差异并进行相关性分析比较。结果:两组患者的性别、年龄、肿瘤大小等因素间差异均无统计学意义(P>0.05),两组之间具有可比性。精细淋巴结分拣组患者淋巴结送检数目明显多于区域淋巴结分拣组(P<0.001)。在T分期、N分期以及TNM分期相同的情况下,精细淋巴结分拣组送检淋巴结数目显著多于区域淋巴结分拣组(P<0.001);精细淋巴结分拣组淋巴结转移数目也显著多于区域淋巴结分拣组(P<0.001)。此外,两组患者送检淋巴结数目与转移淋巴结数目均呈正相关,差异具有统计学意义(精细淋巴结分拣组r=0.181,P=0.023;区域淋巴结分拣组r=0.227,P<0.001),且精细淋巴结分拣组患者的送检淋巴结数目与转移淋巴结数目之间相关性弱于区域淋巴结分拣组患者。结论:胃癌根治术后精细淋巴结分拣可以提高送检淋巴结数目,提供精确的术后淋巴结分期,减少分期迁移,可以在临床上规范性推广。

Clinical value of standardized procedures of fine lymph node sorting from gastric cancer samples after curative resection: a study of 727 cases

  Objective  To evaluate the potential clinical value of standardized procedures of fine lymph node sorting from gastric cancer samples after curative resection.  Methods  Between January 2016 and December 2017, 727 gastric cancer patients who underwent R0 resection in the Tianjin Medical University Cancer Institute and Hospital were retrospectively included and assigned to either the fine lymph node sorting group or regional lymph node sorting group in accordance with the lymph node sorting methods from the tumor samples of all patients. Both the numbers of examined lymph nodes and metastatic lymph nodes were compared between the two groups. Additionally, correlation analyses were performed between the numbers of examined lymph nodes and metastatic lymph nodes in the two groups.  Results  There was no significant difference in sex, age, or tumor size between the two groups (P > 0.05), indicating that there was comparability between the two groups. The number of examined lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P < 0.001). Furthermore, the number of examined lymph nodes in the fine lymph node sorting group was much higher than that in the regional lymph node sorting group with the same pT, pN, or pTNM stage (P < 0.001). The number of metastatic lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P < 0.001). There was a significant positive correlation between the numbers of examined lymph nodes and metastatic lymph nodes in both groups (fine lymph node sorting group r=0.181, P=0.023; regional lymph node sorting group r=0.227, P < 0.001). Additionally, the correlation coefficient between the numbers of examined lymph nodes and metastatic lymph nodes in the fine lymph node sorting group was weaker than that in the regional lymph node sorting group.  Conclusions  The standard procedures of fine lymph node sorting from tumor samples of gastric cancer may increase the number of examined lymph nodes, accurately provide the postoperative pN stage, reduce the stage migration, and should be applied in clinical standardization.