D2＋淋巴结清扫术在进展期远端胃癌治疗中的优势探讨  

Advantage of D2＋ lymph node dissection for distal advanced gastric cancer

作　　者：崔海滨[1,2] 邓靖宇[1] 梁寒[1] 张汝鹏[1] 丁学伟[1] 潘源[1] 王宝贵[1] 武卫鹏 

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科天津市肿瘤防治重点实验室,300060 [2]河北省沧州市中心医院肿瘤外一科工作

出　　处：《中华胃肠外科杂志》2015年第2期127-130,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研究发展计划973计划

摘　　要：目的：探讨D2^＋淋巴结清扫术在进展期远端胃癌治疗中的价值。方法回顾性分析2003年1月至2007年12月天津医科大学肿瘤医院收治的305例进展期远端胃癌患者的临床病理资料，其中68例（22．3％）行D2^＋淋巴结清扫术（D2^＋组），237例（77．7％）行D2淋巴结清扫术（D2组）。对比两种不同范围的淋巴结清扫术对患者预后的影响。结果305例患者中位生存期36月，5年总生存率为40．3％。其中D2^＋组和D2组5年生存率分别为50．4％和37．4％，差异有统计学意义（P＝0．049）。但多因素预后分析显示，淋巴结清扫方式并不是一项独立预后因素（P＝0．174）。分层预后分析显示，对于肿瘤最大径4 cm以上、 Borrmann Ⅲ～Ⅳ型、低-未分化型、T4期、N2期、N3期及No．6组淋巴结阳性患者，D2^＋组患者5年生存率明显高于D2组（均P＜0．05）。结论对于肿瘤较大、分化较差及分期较晚的部分进展期胃癌患者，行D2^＋淋巴结清扫术或可使其生存获益。Objective To evaluate the value of D2^＋ lymph node dissection for patients with distal advanced gastric cancer. Methods Clinicopathological data of 305 cases with distal advanced gastric cancer receiving D2^＋（n=68） or D2 （n=237） lymph node dissection in the Tianjin Cancer Hospital from January 2003 to December 2007 were analyzed retrospectively. The overall 5-year survival rate between the 2 groups. Results The median survival was 36 months and the 5-year overall survival rate was 40.3% in all patients. The 5-year overall survival rates in the D2^＋ and D2 groups were 50.4% and 37.4% respectively, and the difference was statistically significant （P =0.049）. In multivariate prognostic analysis however, the extent of lymph node dissection was not identified as an independent prognostic factor（P=0.174）. Subgroup analysis showed that 5-year survival rate of D2^＋group was significantly higher as compared to D2 group for the following subgroups： maximum diameter of tumor larger than 4 cm （43.9% vs. 27.0%）, Borrmann type Ⅲ-Ⅳ （55.5% vs. 30.1%）, poorly differentiated and undifferentiated tumor （49.8% vs. 37.0%）, T4 stage （47.8% vs. 31.0%）, N2 stage （53.3% vs. 13.9%）, N3 stage （20.0% vs. 9.6%） and positive No.6 lymph nodes （33.1% vs. 16.0%）. Conclusion Compared with D2 lymph node dissection, D2^＋ lymph node dissection may benefit some patients with large, poorly differentiated, or late-stage tumor.

关 键 词：胃肿瘤 进展期 胃肿瘤 远端 D2淋巴结清扫术 生存率 

分 类 号：R735.2[医药卫生—肿瘤]