Metastatic patterns and surgical methods for lymph nodes No.5 and No.6 in proximal gastric cancer
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摘要
Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.Methods: In total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6(lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.Results: The metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively.The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.Conclusions: When lymph node No. 4 is positive(intraoperative pathology) or tumor size ≥5 cm or T4 stage,lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.
Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.Methods: In total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6(lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.Results: The metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively.The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.Conclusions: When lymph node No. 4 is positive(intraoperative pathology) or tumor size ≥5 cm or T4 stage,lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.
Objective: The current surgical treatment guidelines for early proximal gastric cancer(PGC) still lack agreement. Lymphadenectomy of lymph nodes No. 5 and No. 6 is the major difference between total and proximal gastrectomy. We elucidated the appropriate surgical procedure for PGC by investigating the pathological characteristics and prognostic significance of lymph nodes No. 5 and No. 6.Methods: In total, 333 PGC patients who underwent total gastrectomy were enrolled in this study. We investigated their clinicopathological characteristics and the metastatic patterns of the lymph nodes. Patients with metastasis in lymph nodes No. 5 and No. 6 were combined into one group and we compared the difference in survival between those with and without metastasis in lymph nodes No. 5, 6(lymph nodes No. 5 and No. 6 in any group of metastasis) for different subgroups.Results: The metastatic rates for lymph nodes No. 5 and No. 6 in PGC were 9.91% and 16.11%, respectively.The metastatic rate for both lymph nodes No. 5, 6 was 20.42%. Multivariate analysis showed that positive metastasis in lymph node No. 4, depth of invasion, and tumor size were independently correlated with the presence of metastasis in lymph nodes No. 5, 6.Conclusions: When lymph node No. 4 is positive(intraoperative pathology) or tumor size ≥5 cm or T4 stage,lymphadenectomy should be performed for lymph nodes No. 5 and No. 6, and total gastrectomy is recommended.
引文
1.Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldide for 36 cancers in 185countries.CA Cancer J Clin 2018;68:394-424.
2.Chen W,Zheng R,Zhang S,et al.Cancer incidence and mortality in China in 2013:an analysis based on urbanization level.Chin J Cancer Res 2017;29:1-10.
3.Wang S,Freedman ND,Loftfield E,et al.Alcohol consumption and risk of gastric cardia adenocarcinoma and gastric non-cardia adenocarcinoma:A 16-year prospective analysis from the NIH-AARP diet and health cohort.Int J Cancer 2018;143:2749-57.
4.Park JC,Lee YC,Kim JH,et al.Clinicopathological features and prognostic factors of proximal gastric carcinoma in a population with high Helicobacter pylori prevalence:a single-center,large-volume study in Korea.Ann Surg Oncol 2010;17:829-37.
5.Kunisaki C,Shimada H,Nomura M,et al.Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach.Surgery 2005;137:165-71.
6.Yang K,Zhang WH,Chen XZ,et al.Comparison of modified D2 lymphadenectomy versus standard D2lymphadenectomy in total gastrectomy for gastric cancer patients with lymph nodes involvement.Surgery 2015;158:1446-7.
7.Galizia G,Lieto E,De Vita F,et al.Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis.Surgery 2015;157:285-96.
8.Wang W,Zheng C,Fang C,et al.Time trends of clinicopathologic features and surgical treatment for gastric cancer:Results from 2 high-volume institutions in southern China.Surgery 2015;158:1590-7.
9.An JY,Youn HG,Choi MG,et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer.Am J Surg 2008;196:587-91.
10.Sano T,Sasako M,Mizusawa J,et al.Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma.Ann Surg2017;265:277-83.
11.Rosa F,Quero G,Fiorillo C,et al.Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach:a propensity-score-matched analysis of a multicenter western experience(On behalf of the Italian Research Group for Gastric Cancer-GIRCG).Gastric Cancer 2018;21:845-52.
12.Kitamura K,Nishida S,Yamamoto K,et al.Lymph node metastasis in gastric cancer in the upper third of the stomach-surgical treatment on the basis of the anatomical distribution of positive node.Hepatogastroenterology 1998;45:281-5.
13.Song W,Liu Y,Ye J,et al.Proximal gastric cancer:lymph node metastatic patterns according to different T stages dictate surgical approach.Chin Med J(Engl)2014;127:4049-54.
14.Ooki A,Yamashita K,Kikuchi S,et al.Clinical significance of total gastrectomy for proximal gastric cancer.Anticancer Res 2008;28:2875-83.
15.Choi JH,Suh YS,Park SH,et al.Risk factors of microscopic invasion in early gastric cancer.J Gastric Cancer 2017;17:331-41.
16.Pang W,Lou N,Jin C,et al.Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer.Eur J Gastroenterol Hepatol 2016;28:493-502.
17.Lee SL,Lee HH,Ku YM,et al.Usefulness of twodimensional values measured using preoperative multidetector computed tomography in predicting lymph node metastasis of gastric cancer.Ann Surg Oncol 2015;22 Suppl 3:S786-93.
18.Wu XJ,Miao RL,Li ZY,et al.Prognostic value of metastatic lymph node ratio as an additional tool to the TNM stage system in gastric cancer.Eur J Surg Oncol 2015;41:927-33.
19.Son T,Kwon IG,Lee JH,et al.Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer.Oncotarget 2017;8:84515-28.
20.Li H,Huo ZB,Kong FT,et al.Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer.World JGastrointest Oncol 2018;10:360-6.
2.Chen W,Zheng R,Zhang S,et al.Cancer incidence and mortality in China in 2013:an analysis based on urbanization level.Chin J Cancer Res 2017;29:1-10.
3.Wang S,Freedman ND,Loftfield E,et al.Alcohol consumption and risk of gastric cardia adenocarcinoma and gastric non-cardia adenocarcinoma:A 16-year prospective analysis from the NIH-AARP diet and health cohort.Int J Cancer 2018;143:2749-57.
4.Park JC,Lee YC,Kim JH,et al.Clinicopathological features and prognostic factors of proximal gastric carcinoma in a population with high Helicobacter pylori prevalence:a single-center,large-volume study in Korea.Ann Surg Oncol 2010;17:829-37.
5.Kunisaki C,Shimada H,Nomura M,et al.Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach.Surgery 2005;137:165-71.
6.Yang K,Zhang WH,Chen XZ,et al.Comparison of modified D2 lymphadenectomy versus standard D2lymphadenectomy in total gastrectomy for gastric cancer patients with lymph nodes involvement.Surgery 2015;158:1446-7.
7.Galizia G,Lieto E,De Vita F,et al.Modified versus standard D2 lymphadenectomy in total gastrectomy for nonjunctional gastric carcinoma with lymph node metastasis.Surgery 2015;157:285-96.
8.Wang W,Zheng C,Fang C,et al.Time trends of clinicopathologic features and surgical treatment for gastric cancer:Results from 2 high-volume institutions in southern China.Surgery 2015;158:1590-7.
9.An JY,Youn HG,Choi MG,et al.The difficult choice between total and proximal gastrectomy in proximal early gastric cancer.Am J Surg 2008;196:587-91.
10.Sano T,Sasako M,Mizusawa J,et al.Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma.Ann Surg2017;265:277-83.
11.Rosa F,Quero G,Fiorillo C,et al.Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach:a propensity-score-matched analysis of a multicenter western experience(On behalf of the Italian Research Group for Gastric Cancer-GIRCG).Gastric Cancer 2018;21:845-52.
12.Kitamura K,Nishida S,Yamamoto K,et al.Lymph node metastasis in gastric cancer in the upper third of the stomach-surgical treatment on the basis of the anatomical distribution of positive node.Hepatogastroenterology 1998;45:281-5.
13.Song W,Liu Y,Ye J,et al.Proximal gastric cancer:lymph node metastatic patterns according to different T stages dictate surgical approach.Chin Med J(Engl)2014;127:4049-54.
14.Ooki A,Yamashita K,Kikuchi S,et al.Clinical significance of total gastrectomy for proximal gastric cancer.Anticancer Res 2008;28:2875-83.
15.Choi JH,Suh YS,Park SH,et al.Risk factors of microscopic invasion in early gastric cancer.J Gastric Cancer 2017;17:331-41.
16.Pang W,Lou N,Jin C,et al.Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer.Eur J Gastroenterol Hepatol 2016;28:493-502.
17.Lee SL,Lee HH,Ku YM,et al.Usefulness of twodimensional values measured using preoperative multidetector computed tomography in predicting lymph node metastasis of gastric cancer.Ann Surg Oncol 2015;22 Suppl 3:S786-93.
18.Wu XJ,Miao RL,Li ZY,et al.Prognostic value of metastatic lymph node ratio as an additional tool to the TNM stage system in gastric cancer.Eur J Surg Oncol 2015;41:927-33.
19.Son T,Kwon IG,Lee JH,et al.Impact of splenic hilar lymph node metastasis on prognosis in patients with advanced gastric cancer.Oncotarget 2017;8:84515-28.
20.Li H,Huo ZB,Kong FT,et al.Predictive factors for lymph node metastasis and defining a subgroup treatable for laparoscopic lymph node dissection after endoscopic submucosal dissection in poorly differentiated early gastric cancer.World JGastrointest Oncol 2018;10:360-6.