淋巴结转移率与Ⅲ期胃癌患者D2根治术后生存率和化疗获益的关系研究

吴海滨; 张华秦; 谢辉; 刘勇

doi:10.3969/j.issn.1671-038X.2019.05.09

淋巴结转移率与Ⅲ期胃癌患者D2根治术后生存率和化疗获益的关系研究

- 延安市人民医院普外科, 陕西延安 716000

详细信息

作者简介:
吴海滨, 男, 本科, 主治医师, 研究方向:肝胆、胃肠

通讯作者: 刘勇, E-mail:870234948@qq.com

中图分类号: R735.2

收稿日期: 2019-01-10

The relationship between metastatic lymph node ratio and prognosis in stage Ⅲ gastric cancer after D2 nodal dissection

- Department of General Surgery, Yan'an People's Hospital, Shaanxi, Yanan 716000, China

More Information

Corresponding author: LIU Yong, E-mail: 870234948@qq.com

Received Date: 10 January 2019

摘要

摘要: [目的]研究淋巴结转移率 (MLR) 与Ⅲ期胃癌患者D2根治术后生存率和化疗获益的关系。[方法]选取2010年1月~2013年12月我院收治的87例Ⅲ期胃癌患者作为研究对象, 进行回顾性研究。患者行胃癌R0切除伴D2淋巴结清扫术, 其中83例接受胃全切除, 4例接受胃大部切除术;57例患者接受含5-Fu的辅助化疗。通过Kaplan-Meier法分析患者生存率。[结果]淋巴结总数的中位值是35 (10~104) , 转移淋巴结的中位数是8 (0~71) 。中位生存期31.7个月, 3年生存率36.4%。患者按MLR分为4组:MLR0, 0;MLR1, <0.1;MLR2, 0.1~0.25;MLR3, >0.25。中位随访31个月后, MLR0到MLR3组患者中位生存时间分别是37.1个月、35.9个月、31.5个月、20.8个月 (P=0.013) 。选取中位值0.24作为MLR高低的临界值, MLR<0.24的患者中, 采用辅助化疗和不采用辅助化疗的中位生存期分别是39.3个月和36.5个月。MLR>0.24的患者中, 采用辅助化疗和不采用辅助化疗的中位生存期分别是22.9个月和12.2个月 (P=0.002) 。多变量分析表明, MLR是一个独立的预后因素。[结论]Ⅲ期胃癌患者行R0切除伴D2淋巴结清扫术后, MLR是一个有效的预后指标;高MLR患者可能从辅助化疗中获益最多。
- 淋巴结转移率 /
- 胃癌 /
- D2淋巴结清扫 /
- 预后
Abstract: [Objective] To investigate the prognostic value of metastatic lymph node ratio (MLR) and adjuvant chemotherapy in Ⅲ gastric cancer after D2 nodal dissection. [Methods]A total of 87 gastric cancer patients from January 2010 to December 2013 were retrospectivelyenrolled in this study.Of these patients, 83 underwent total gastrectomy, the remaining 4 underwent subtotal gastrectomy and 57 patients received adjuvant chemotherapy with fluoropyrimidines.Survival analysis was determined by the Kaplan-Meier method. [Results]Median total retrieved lymph node number was 35 (range: 10-104) with median metastatic lymph node amount of eight (range: 0-71) . Median survival time was 31.7 months with a 3-year survival rate of 36.4%. Patients were divided into four groups according to MLR: MLR0, 0; MLR1, <0.1; MLR2, 0.1-0.25; MLR3, >0.25. After median follow-up of 31 months, median OS rates of MLR0 to MLR3 were 37.1 m, 35.9 m, 31.5 m and 20.8 m, respectively (P=0.013) . Median survival time were 9.3 m and 36.5 m in low subgroups (MLR<0.24) with or without adjuvant chemotherapy; 22.9 m and 12.2 m were found in high subgroups (MLR>0.24) with and without chemotherapy, respectively (P=0.002) . Finally, MLR constituted an independent prognostic factor in multivariable analysis. [Conclusion]After R0 resection with D2 lymphadenectomy for stage Ⅲ gastric cancer, MLR constitutes an effective prognostic indicator. Patients with high MLR may benefit from adjuvant chemotherapy.
- MLR /
- gastric cancer /
- D2 nodal dissection /
- prognosis

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参考文献(17)

[1]	陈万青, 孙可欣, 郑荣寿, 等.2014年中国分地区恶性肿瘤发病和死亡分析[J].中国肿瘤, 2018, 27 (1):1-14.
[2]	Van Cutsem E, Sagaert X, Topal B, et al.Gastric cancer[J].The Lancet, 2016, 388 (10060):2654-2664.
[3]	Massagué J, Batlle E, Gomis RR.Understanding the molecular mechanisms driving metastasis[J].Molecular oncology, 2017, 11 (1):3-4.
[4]	陕飞, 李子禹, 张连海, 等.国际抗癌联盟及美国肿瘤联合会胃癌TNM分期系统简介及解读[J].中国实用外科杂志, 2017, 37 (1):15-17.
[5]	Yamashita K, Hosoda K, Ema A, et al.Lymph node ratio as a novel and simple prognostic factor in advanced gastric cancer[J].Eur J Surg Oncol (EJSO), 2016, 42 (9):1253-1260.
[6]	金俊蕊, 邓靖宇, 梁寒.胃癌淋巴结分期的临床变革及分期方法的研究进展[J].中国肿瘤临床, 2016, 43 (15):683-689.
[7]	Go Y, Tanaka H, Tokumoto M, et al.Tumor-associated macrophages extend along lymphatic flow in the pre-metastatic lymph nodes of human gastric cancer[J].Ann Surg Oncol, 2016, 23 (2):230-235.
[8]	郗洪庆, 张珂诚, 卫勃.胃癌TNM分期第八版更新在临床诊断治疗中的意义和思考[J].中华胃肠外科杂志, 2017, 20 (2):166-170.
[9]	Lorenzon L, Mercantini P, Ferri M, et al.Lymph-node ratio classification strongly correlates with cancer survivals of patients who underwent R0 resection for gastric cancer with more than 15 nodes harvested[J].Eur Surg Res, 2014, 53 (1-4):1-10.
[10]	黎焕君, 刘琦, 陈志良, 等.淋巴结转移率对胃癌D2根治术患者的预后分析[J].肿瘤学杂志, 2016 (4):300-304.
[11]	权峰涛, 杨维桢.淋巴结转移率在评估胃癌患者预后中的价值[J].中国临床研究, 2017, 30 (6):804-806.
[12]	李晨, 杜晓辉, 陈凛.胃癌淋巴结转移率分期的研究现状[J].解放军医学院学报, 2014, 35 (6):634-636.
[13]	封晓昆, 韩悦, 石英, 等.淋巴结转移率对各pT分期胃癌患者生存状况的评估效果[J].中国医学前沿杂志, 2015, 7 (5):58-60.
[14]	陈思曾, 穆建成.老年人胃癌淋巴结转移率与病理及临床预后的关系[J].中华老年医学杂志, 2015, 34 (10):1088-1090.
[15]	Noh SH, Park SR, Yang HK, et al.Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):5-year follow-up of an open-label, randomised phase 3 trial[J].Lancet oncol, 2014, 15 (12):1389-1396.
[16]	Park SH, Sohn TS, Lee J, et al.Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer:final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses[J].J Clin Oncol, 2015, 33 (28):3130-3136.
[17]	翟璐, 陈环球, 陆建伟, 等.晚期胃癌化疗严重不良反应的相关因素分析[J].临床合理用药杂志, 2018, 11 (5):16-17.