中国普外基础与临床杂志

中国普外基础与临床杂志

肝十二指肠韧带淋巴结转移对胃癌患者预后影响的研究

查看全文

目的 评估肝十二指肠韧带淋巴结(HDLN)转移的影响因素,及其对行根治性胃切除术的胃癌患者预后的影响。 方法 回顾性分析 2010 年 1 月至 2015 年 6 月期间于笔者所在医院接受胃癌根治术及 HDLN 清扫的 273 例胃癌患者的临床资料。 结果 273 例患者中,有 96 例发生 HDLN 转移。非条件 logistic 回归分析结果显示,年龄、T 分期、M 分期和病理阶段是 HDLN 转移的影响因素(P<0.05)。log-rank 检验结果表明,病理阶段和 HDLN 转移情况是总生存期(OS)和无进展生存期(PFS)的影响因素(P<0.05)。对于 Ⅳ 期患者(包括 2 种 HDLN 状态)而言,Ⅰ~Ⅲ 期 HDLN 阳性和 Ⅰ~Ⅲ 期阴性患者的生存情况均较优(P<0.05)。Ⅰ、Ⅱ 及 Ⅲ 期患者中,HDLN 阳性患者的生存情况均明显差于同期 HDLN 阴性患者(P<0.001),且 Ⅲ 期 HDLN 阳性患者的生存情况最差(P=0.001)。 结论 HDLN 状态可以作为胃癌的独立预后因子。

Objective To explore the influencing factors of hepatoduodenal ligament lymph node (HDLN), and to analyze the prognostic significance of HDLN metastasis for gastric cancer patients undergone radical gastrectomy. Methods The records and pathological data of gastric cancer patients treated in our hospital from Jan. 2010 to Jun. 2015 were retrospectively analyzed. Results The total number of patients included in this study was 273, of which 96 had lymph node metastasis of the HDLN. Results of unconditional logistic regression analysis showed that age, T staging, M staging, and pathological staging were influencing factors for HDLN metastasis (P<0.05). Results of log-rank test showed that, pathological staging and HDLN status were influencing factors for prognosis of patients undergone radical gastrectomy (P<0.05). For Ⅳ pathological staging patients, the overall survival situation was better in Ⅰ–Ⅲ pathological staging+positive-HDLN group and Ⅰ–Ⅲ pathological staging+negative-HDLN group (P<0.05). For patients in Ⅰ, Ⅱ, and Ⅲ pathological staging, patients in positive-HDLN group had bad survival situation than those of negative-HDLN group in the same pathological staging (P<0.001), and patients in Ⅲ pathological staging+positive-HDLN had the worst prognosis (P=0.001). Conclusion The status of HDLN can be used as an independent prognostic factor for prognosis of gastric cancer.

关键词: 胃癌; 肝十二指肠韧带淋巴结; D2 切除; 胃切除术

Key words: gastric cancer; hepatoduodenal ligament lymph node; D2 dissection; gastrectomy

引用本文: 王利锋, 马艳飞, 高强. 肝十二指肠韧带淋巴结转移对胃癌患者预后影响的研究. 中国普外基础与临床杂志, 2018, 25(11): 1337-1342. doi: 10.7507/1007-9424.201804083 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 徐惠绵, 孙哲. 胃癌外科病理分期的若干问题. 中国肿瘤临床, 2012, 39(20): 1462-1465.
2. Shimada H, Fukagawa T, Haga Y, et al. Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association. Gastric Cancer, 2016, 19(2): 339-349.
3. Jongerius EJ, Boerma D, Seldenrijk KA, et al. Role of omentectomy as part of radical surgery for gastric cancer. Br J Surg, 2016, 103(11): 1497-1503.
4. Gu J, Hao C, Yan X, et al. Applied analysis of ultrasound-guided ilioinguinal and iliohypogastric nerve blocks in the radical surgery of aged cervical cancer. Oncol Lett, 2017, 13(3): 1637-1640.
5. 季加孚. 胃癌外科治疗研究现状与发展趋势. 医学研究杂志, 2008, 37(1): 4.
6. Vardevanyan H, Holzinger J, Forstner R. Hepatoduodenal lymph node metastasis mimicking Klatskin tumor in a patient with sigmoid colon mucinous cancer. Radiol Case Rep, 2017, 12(3): 494-499.
7. 何裕隆. 进展期胃癌扩大根治手术合理选择及评价. 中国实用外科杂志, 2008, 28(9): 722-725.
8. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer, 2017, 20(1): 1-19.
9. Vega EA, Vinuela E, Yamashita S, et al. Extended lymph- adenectomy is required for incidental gallbladder cancer independent of cystic duct lymph node status. J Gastrointest Surg, 2018, 22(1): 43-51.
10. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol, 2010, 17(12): 3077-3079.
11. Chun YS, Pawlik TM, Vauthey JN. 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol, 2018, 25(4): 845-847.
12. Yamashita K, Ema A, Hosoda K, et al. Macroscopic appearance of type Ⅳ and giant type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with post- operative adjuvant chemotherapy. World J Gastrointest Oncol, 2017, 9(4): 166-175.
13. Talsma K, Hagen PV, Grotenhuis BA, et al. Comparison of the 6th and 7th editions of the UICC-AJCC TNM Classification for Esophageal Cancer. Ann Surg Oncol, 2012, 19(7): 2142-2148.
14. Ide S, Toiyama Y, Shimura T, et al. Angiopoietin-like protein 2 acts as a novel biomarker for diagnosis and prognosis in patients with esophageal cancer. Ann Surg Oncol, 2015, 22(8): 2585-2592.
15. Lee SL, Lee HH, Ko YH, et al. Relevance of hepatoduodenal ligament lymph nodes in resectional surgery for gastric cancer. Br J Surg, 2014, 101(5): 518-522.
16. Mocellin S, Nitti D. Lymphadenectomy extent and survival of patients with gastric carcinoma: a systematic review and meta-analysis of time-to-event data from randomized trials. Cancer Treat Rev, 2015, 41(5): 448-454.
17. Oh SE, Choi MG, Lee JH, et al. Prognostic implication of hepatoduodenal ligament lymph nodes in gastric cancer. Medicine (Baltimore), 2017, 96(13): e6464-e6468.
18. El-Sedfy A, Dixon M, Seevaratnam R, et al. Personalized surgery for gastric adenocarcinoma: a meta-analysis of D1 versus D2 lymphadenectomy. Ann Surg Oncol, 2015, 22(6): 1820-1827.
19. van de Velde CJ. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer (Br J Surg 2014; 101: 23-31). Br J Surg, 2014, 101(2): 31-32.
20. 金鑫, 冯利, 李福广. 进展期胃癌肝十二指肠韧带淋巴结转移的危险因素及其对预后的影响. 中国普外基础与临床杂志, 2016, 23(7): 838-842.
21. 缪文忠, 孙金兵, 蒋建龙. 胃癌根治术中No12a 淋巴结清扫 60 例分析. 徐州医学院学报, 2013, 33(8): 522-524.
22. 尤小兰, 王元杰, 李文琦, 等. 进展期胃癌肝十二指肠韧带淋巴结清扫的临床意义. 中华胃肠外科杂志, 2017, 20(3): 283-288.
23. Aisu Y, Furuyama H, Hori T, et al. Solitary metastasis to a distant lymph node in the descending mesocolon after primary resection for hepatocellular carcinoma: is surgical resection valid? Am J Case Rep, 2016, 17: 909-915.
24. Takeshita N, Fukunaga T, Kimura M, et al. Successful resection of metachronous para-aortic, virchow lymph node and liver metastatic recurrence of rectal cancer. World J Gastroenterol, 2015, 21(44): 12722-12728.
25. Kayahara M, Nagakawa T, Kobayashi H, et al. Lymphatic flow in carcinoma of the head of the pancreas. Cancer, 1992, 70(8): 2061-2066.
26. Schreiber-Dietrich D, Pohl M, Cui XW, et al. Perihepatic lymphadenopathy in children with chronic viral hepatitis. J Ultrason, 2015, 15(61): 137-150.