新辅助化疗对胃癌淋巴结分期评估以及预后的影响

Effect of Neoadjuvant Chemotherapy in Lymph Node Staging Assessment and Prognosis of Gastric Cancer

目的:评估新辅助化疗对胃癌患者淋巴结分期评估及预后的影响。方法:选取2007年9月—2011年9月收治的部分胃癌患者进行随机对照研究。58例术前临床分期为ⅢA、ⅢB、ⅢC期的胃癌患者行术前化疗为新辅助化疗组,168例直接手术的胃癌患者为直接手术组,对两者淋巴结情况和预后相关因素进行对比分析。结果:与直接手术组比较,新辅助化疗组患者术后总淋巴结数明显减少[(29.6±11.7)vs(25.3±12.6),P<0.05],小于15枚淋巴结的病例数明显减少[(14/168)vs(13/58),P<0.01]。同时,新辅助化疗组转移的淋巴结数明显减少[(9.8±2.5)vs(5.7±3.4),P<0.05],淋巴结分期显示N2分期[(90/168)vs(17/58),P<0.01]和N3分期[(58/168)vs(9/58),P<0.01]患者明显减少,N1期[(19/168)vs(30/58),P<0.01]患者明显增多。同时,与直接手术组比较,新辅助化疗组能提高患者的3年[47.6%vs 63.8%,P<0.01]和5年(22.7%vs 34.5%,P<0.01)生存率。结论:新辅助化疗可降低胃癌患者术后淋巴结总数,减少转移的淋巴结数,降低患者临床病理分期,提高生存率。

Objective To explore the effect of neoadjuvant chemotherapy in the lymph node staging assessment and prognosis of gastric cancer.Methods A randomized controlled study was conducted by selecting patients with gastric cancer from September 2007 to September 2011.Fifty-eight patients with stagesⅢA,ⅢB,ⅢC gastric cancer received preoperative chemotherapy were compared with 168 patients with gastric cancer received surgery directly.The lymph nodes were harvested in the two groups and prognostic factors were comparatively analyzed.Results Compared to the group of surgery directly,the number of lymph nodes harvested were obviously decreased in the group of preoperative chemotherapy[(29.6±11.7)vs(25.3±12.6),P<0.05].And the cases of lymph nodes harvested less than 15 were also decreased obviously[(9.8±2.5)vs(5.7±3.4),P<0.05].Meanwhile,in the group of preoperative chemotherapy,the number of lymph nodes metastasis were decreased obviously[(9.8±2.5)vs(5.7±3.4),P<0.05],and in the stage of lymph nodes,the cases were decreased obviously which belonged to N2 and N3[(90/168)vs(17/58),P<0.005;(58/168)vs(9/58),P<0.01]respectively,but the cases were distinctly increased belonging to N1[19/168)vs(30/58),P<0.01].Compared to the group of surgery directly,the survival rates of 3 years and 5 years in the group of preoperative chemotherapy were improved(47.6%vs 63.8%,P<0.01 and 22.7%vs 34.5%,P<0.01).Conclusion Preoperative chemotherapy can reduce the number of the total and metastatic lymph nodes in postoperative gastric cancer patients,reduce the clinical pathological stage and improve the survival rate.