摘要
AIM:To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS: Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes (LNs) dissected and survival was analyzed among different clinical stage subgroups. RESULTS: The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected (P < 0.0001; or number of negative LNs examined, P < 0.0001), number of positive LNs (P < 0.0001), T category (P < 0.0001) and tumor size (P = 0.015). The greatest survival differences were observed at cutoff values of 20 LNs resected for stage Ⅱ (P = 0.0136), 25 for stage Ⅲ (P < 0.0001), 30 for stage Ⅳ (P = 0.0002), and 15 for all patients (P = 0.0024). Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages Ⅲ (P = 0.013) and Ⅳ (P = 0.035). CONCLUSION: To improve the long-term survival of patients with advanced gastric cancer located inthe cardia and fundus, removing at least 20 LNs for stage Ⅱ, 25 LNs for stage Ⅲ, and 30 LNs for stage Ⅳ patients during D2 radical dissection is recommended.
AIM: To analyze the prognostic impact of lymphade-nectomy extent in advanced gastric cancer located in the cardia and fundus. METHODS: Two hundred and thirty-six patients with advanced gastric cancer located in the cardia and fundus who underwent D2 curative resection were analyzed retrospectively. Relationships between the numbers of lymph nodes (LNs) dissected and survival was analyzed among different clinical stage subgroups. RESULTS: The 5-year overall survival rate of the entire cohort was 37.5%. Multivariate prognostic variables were total LNs dissected (P 〈 0.0001; or number of negative LNs examined, P 〈 0.0001), number of positive LNs (P 〈 0.0001), T category (P 〈 0.0001) and tumor size (P = 0.015). The greatest survival differences were observed at cutoff values of 20 LNs resected for stage Ⅱ(p = 0.0136), 25 for stage Ⅲ(P 〈 0.0001), 30 for stage Ⅳ(P = 0.0002), and 15 for all patients (P = 0.0024). Based on the statistically assumed linearity as best fit, linear regression showed a significant survival enhancement based on increasing negative LNs for patients of stages Ⅲ (P = 0.013) and Ⅳ(P = 0.035). CONCLUSION: To improve the long-term survival of patients with advanced gastric cancer located in the cardia and fundus, removing at least 20 LNs for stage Ⅱ,25 LNs for stage Ⅲ, and 30 LNs for stage N patients during D2 radical dissection is recommended.
基金
The Follow-up Office established by the Department of Oncology,Affiliated Union Hospital of Fujian Medical University,Fujian Province,China
关键词
胃癌
贲门
手术治疗
预后
Stomach neoplasms
Lymph node meta-stasis
Surgery
Lymphadenectomy
Prognosis