进展期胃癌D2根治术中第14v组淋巴结清扫的意义

Significance of No.14v lymph node dissection for advanced gastric cancer undergoing D2 lymphadenctomy

目的探讨进展期胃癌行D：根治术时第14v组淋巴结清扫的必要性。方法回顾性分析2003至2007年间天津医科大学附属肿瘤医院收治的131例行胃癌根治术（D2或D2＋）并同时加行第14v组淋巴结清扫的胃癌患者的临床病理资料，分析影响第14v组淋巴结转移的临床病理因素以及第14v组淋巴结转移与预后的关系。结果131例患者中24例（18．3％）有第14v组淋巴结转移。原发灶部位、肿瘤大小、浸润深度、淋巴结分期、TNM分期、第1、6、8a组淋巴结转移与第14v组淋巴结转移有关（均P〈0．05）；其中原发灶部位和淋巴结分期是影响第14v组淋巴结转移的独立因素（均P〈0．05）。第14v组淋巴结转移和未转移患者5年生存率分别为8．3％和37．8％，差异有统计学意义（P〈0．01）。多因素预后分析证实。第14v组淋巴结转移是影响进展期胃癌D：根治术后生存的独立危险因素（P=-0．029，RR=1．807，95％CI：1．064-3．070）。结论对于进展期胃中下部癌．尤其是肿瘤体积较大、浆膜受侵犯、第6组淋巴结可疑转移的患者，第14v组淋巴结清扫是必要可行的。

Objective To elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer. Methods Clinicopathologieal data of 131 cases of advanced gastric cancer receiving D2 or D2 ＋ plus No.14v lymph node dissection were reviewed retrospectively. Clinieopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated. Results Of the 131 patients, 24 （18.3%） had positive No.14v lymph node. The incidence of 14v metastasis was associated with tumor location, tumor size, depth of invasion, N staging, TNM staging, No.I, No.6, and No.8a lymph nodes metastasis. Tumor location and N staging were independent risk factors for No. 14v metastasis （all P〈0.05 ）. The 5-year survival rate was 8.3% and 37.8% in patients with and without No.14v metastasis respectively. The difference was statistically significant （P〈0.01）. Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy （P=0.029, RR=l.807, 95%CI： 1.064-3.070）. Conclusions For advanced middle and lower gastric cancers, especially those with larger size, serosa invasion and possibility of No.6 lymph node metastasis, it is necessary and feasible to remove the No.14v lymph node.