Long-term survival of patients with stage Ⅱ and Ⅲgastric cancer who underwent gastrectomy with inadequate nodal assessment  

作　　者：Jacopo Desiderio Andrea Sagnotta Irene Terrenato Eleonora Garofoli Claudia Mosillo Stefano Trastulli Federica Arteritano Federico Tozzi Vito D'Andrea Yuman Fong Yanghee Woo Sergio Bracarda Amilcare Parisi 

机构地区：[1]Department of Digestive Surgery,St.Mary’s Hospital,Terni 05100,Italy [2]Department of Surgical Sciences,Sapienza University of Rome,Rome 00161,Italy [3]Department of General Surgery and Surgical Oncology,San Filippo Neri Hospital,Rome 00135,Italy [4]Biostatistics and Bioinformatic Unit,Scientific Direction,IRCCS Regina Elena National Cancer Institute,Rome 00144,Italy [5]Department of Medical Oncology,St.Mary’s Hospital,Terni 05100,Italy [6]Division of Surgical Oncology and Endocrine Surgery,Mays Cancer Center,University of Texas Health Science Center San Antonio,San Antonio,TX 78229,United States [7]Division of Surgical Oncology,Department of Surgery,City of Hope National Medical Center,Duarte,LA,91010,United States

出　　处：《World Journal of Gastrointestinal Surgery》2021年第11期1463-1483,共21页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Gastric cancer is an aggressive disease with frequent lymph node(LN)involvement.The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs.This threshold has been the subject of great debate,not only for the extent of surgery but also for more appropriate staging.The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer(AJCC)staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number.Furthermore,studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastriccancer.AIM To evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation.METHODS Eligible patients were identified from the Surveillance,Epidemiology,and End Results database.Those with stage II-III gastric cancer were considered for inclusion.Three groups were compared based on the number of analyzed LNs.They were inadequate LN assessment(ILA,<16 LNs),adequate LN assessment(ALA,16-29 LNs),and optimal LN assessment(OLA,≥30 LNs).The main outcomes were overall survival(OS)and cancer-specific survival.Data were analyzed by the Kaplan-Meier product-limit method,log-rank test,hazard risk,and Cox proportional univariate and multivariate models.Propensity score matching(PSM)was used to compare the ALA and OLA groups.RESULTS The analysis included 11607 patients.Most had advanced T stages(T3=48%;T4=42%).The pathological AJCC stage distribution was IIA=22%,IIB=18%,IIIA=26%,IIIB=22%,and IIIC=12%.The overall sample divided by the study objective included ILA(50%),ALA(35%),and OLA(15%).Median OS was 24 mo for the ILA group,29 mo for the ALA group,and 34 mo for the OLA group(P<0.001).Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group[ALA hazard ratio(HR)=0.84,95%confidence interval(CI):0.79-0.88,P<0.001 and OL

关 键 词：Gastric Cancer LYMPHADENECTOMY GASTRECTOMY STAGING N stage Surveillance Epidemiology and End Results 

分 类 号：R735.2[医药卫生—肿瘤]