N3期胃癌D2联合腹主动脉旁淋巴结清扫对患者生存预后的影响  

The prognostic influence of D2 lymphadenectomy with para-aortic lymph nodal dissection for gastric cancer in N3 stage

作　　者：梁月祥[1] 梁寒[1] 丁学伟[1] 王晓娜[1] 张李[1] 吴亮亮[1] 刘宏根[1] 焦旭光[1] 

机构地区：[1]天津医科大学附属肿瘤医院胃部肿瘤科国家肿瘤临床医学研究中心天津市“肿瘤防治”重点实验室,300060

出　　处：《中华外科杂志》2013年第12期1071-1076,共6页Chinese Journal of Surgery

基　　金：国家重点研究发展计划（973计划）资助项目（2010CB529301）;天津医科大学科学基金资助项目（2010KY34）

摘　　要：目的 探讨N3期胃癌D2根治术腹主动脉旁淋巴结（PAL）清扫的必要性.方法 回顾性分析2003年1月至2007年12月收治的278例N3期胃癌患者的临床病理资料,其中男性180例,女性98例;中位年龄61岁（26 ～ 93岁）.患者均接受手术治疗,其中R0切除246例,R1切除32例.D1淋巴结清扫125例,D2淋巴结清扫109例,D2＋腹主动脉旁淋巴结清扫（PAND）44例.术式包括全胃切除98例,次全切除180例.分析淋巴结清扫范围对患者预后的影响.结果 N3期胃癌各组淋巴结转移率均较高,其中第16组淋巴结转移率达34.1％.Borrmann分型（HR=1.350,95％CI：1.018 ～ 1.790,P=0.037）、手术根治程度（HR=1.580,95％CI：1.076 ～2.322,P=0.020）、浸润深度（HR=1.697,95％ CI：1.005 ～2.864,P=0.048）、淋巴结转移率（HR=1.631,95％CI：1.261～2.111,P=0.000）、软组织浸润（HR=1.336,95％CI：1.027 ～1.738,P=0.031）、术后辅助化疗（HR=1.312,95％CI：1.015 ～1.696,P=0.038）、淋巴结清扫范围（HR=1.488、2.114,P=0.054、0.000）及淋巴结检出数目（HR=1.503、2.112,P=0.025、0.000）与N3期患者预后显著相关.多因素分析显示,仅Borrmann分型（HR=1.399,95％ CI：1.050 ～1.863,P=0.022）、淋巴结转移率（HR=1.353,95％CI：1.016 ～1.802,P=0.039）及清扫范围（HR=1.725,95％CI：1.111 ～2.678,P=0.015）是N3期患者的独立预后因素.结论 N3期患者至少应检出30枚淋巴结,D2＋ PAND可能提高N3期胃癌患者总体生存率.Objective To elucidate the necessity of para-aortic lymph nodal dissection in D2 lymphadenectomy for gastric cancer in N3 stage.Methods A total of 278 gastric cancer patients staged N3 who underwent gastrectomy between January 2003 and December 2007 were enrolled.There were 180 male and 98 female patients,and the patients＇ age were 26-93 years （median was 61 years）.All patients had undergone surgical treatment.There were R0 resection in 246 cases and R1 resection in 32 cases.Lymph node dissection included D1 lymphadenectomy with 125 cases,D2 lymphadenectomy with 109 cases and D2 ＋ para-aortic lymph nodal dissection（PAND） with 44 cases.The surgical approach were total gastrectomy （98 cases） and subtotal gastrectomy （180 cases）.Potential prognostic factors were analyzed.Results The lymph node metastasis of each station was high in gastric cancer patients staged N3 and 34.1％ patients had the para-aortic lymph nodal metastasis.Borrmann type （HR =1.350,95％ CI：1.018-1.790,P =0.037）,curability （HR =1.580,95％ CI：1.076-2.322,P =0.020）,depth of invasion （HR =1.697,95％ CI：1.005-2.864,P =0.048）,metastatic lymph node ratio （HR =1.631,95％ CI：1.261-2.111,P =0.000）,extranodal metastasis （HR =1.336,95％ CI：1.027-1.738,P =0.031）,postoperative adjuvant chemotherapy （HR =1.312,95％ CI：1.015-1.696,P =0.038）,extent of lymphadenectomy （HR =1.488 and 2.114,P =0.054 and 0.000） and number of retrieved lymph node （HR =1.503 and 2.112,P =0.025 and 0.000） were found to be factors correlated to overall survival.In multivariate analysis,only Borrrnann type （HR =1.399,95％ CI：1.050-1.863,P =0.022）,metastatic lymph node ratio （HR =1.353,95％ CI：1.016-1.802,P =0.039） and extent of lymphadenectomy （HR =1.725,95％ CI：1.111-2.678,P =0.015） were independent prognostic factors for gastric cancer patients in N3 stage.Conclusions Patients in N3 stage should at least have 30 lymph node examined.D2 lymph node dissection plus PAND may improve the overall surviv

关 键 词：胃肿瘤 淋巴结切除术 预后 因素分析 统计学 

分 类 号：R735.2[医药卫生—肿瘤]