SiewertⅡ/Ⅲ型食管胃结合部腺癌腹腔各组淋巴结转移率的meta分析和系统评价

Metastasis rate of intraperitoneal lymph nodes in Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction: a meta-analysis and systematic evaluation

目的 分析SiewertⅡ/Ⅲ型食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG腹腔各组淋巴结转移率情况,以帮助确定最合适的淋巴结清扫范围。方法 在PubMed、Medline和Cochrane Library数据库中系统而全面地检索了关于SewiertⅡ/Ⅲ型AEG患者的淋巴结转移情况的研究报道,时限从建库至2021年10月1日。对腹腔各组淋巴结转移率进行汇总分析,同时分析了AEG淋巴结转移的影响因素。结果 最终纳入相关研究22篇共3 934例患者。SiewertⅡ/Ⅲ型AEG患者的淋巴结转移率:No.1、2、1&2、3、7均≥20%,No.4、9、11(11p+11d)、11p、16为10%~20%(含10%),No.4sa、8a、10、11d为5%~10%(含5%),其余均<5%;SiewertⅡ型AEG患者的淋巴结转移率:No. 1、2、1&2、3、7均≥20%,No.4、9、11(11p+11d)、11p为10%~20%(含10%),No.8a、10为5%~10%(含5%),其余均<5%;SiewertⅢ型AEG患者的淋巴结转移率:No.1、2、1&2、3、4、7均≥20%,No.11p为10%~20%(含10%),No.4sa、4sb、4d、8a、9、10、11(11p+11d)、11d为5%~10%(含5%),其余均<5%。SiewertⅡ、Ⅲ型或Ⅱ/Ⅲ型AEG患者的No.5、6、12a淋巴结转移率均<5%。肿瘤直径≥2 cm、T分期较高(T2~T4)增加SiewertⅡ/Ⅲ型AEG淋巴结转移的概率(P<0.05)。结论 本meta分析结果结合文献提示,在临床实践中,对于SiewertⅡ型以及直径<2 cm且肿瘤侵犯深度较浅(T1)的SiewertⅢ型AEG患者可不必行No.10淋巴结清扫;无论是SiewertⅡ型还是Ⅲ型AEG,只要满足肿瘤长径<2 cm且肿瘤侵犯深度较浅(T1)者可不行远端胃周(No.4d、5、6)淋巴结清扫;SiewertⅡ型或Ⅲ型AEG患者均可不必清扫No.12a淋巴结。

Objective To analyze rate of intraperitoneal lymph node metastasis(LNM) in Siewert type Ⅱ/Ⅲadenocarcinoma of esophagogastric junction(AEG) so as to determine optimal extent of lymph node dissection.Methods A systematic and comprehensive search of PubMed, Medline, and Cochrane Library databases for study reports on LNM in patients with Siewert type Ⅱ/Ⅲ AEG was performed. The retrieval time ranged from database establishment to October 1, 2021. The pooled LNM rate was analyzed for each lymph node group. In addition, the influencing factors of LNM in AEG were analyzed. Results After screening, a total of 22 relevant studies were included,with a total of 3 934 cases. For the patients with Siewert type Ⅱ/Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11(11p+11d), 11p, 16 lymph nodes were 10%–20%, LNM rates of No.4sa, 8a, 10,11d lymph nodes were 5%–10%, the rest were <5%. For the patients with Siewert type Ⅱ AEG, the LNM rates of No.1,2, 1&2, 3, 7 lymph nodes were ≥20%, LNM rates of No.4, 9, 11(11p+11d), 11p lymph nodes were 10%–20%, LNM rates of No.8a, 10 lymph nodes were 5%–10%, and the rest were <5%. For the patients with Siewert type Ⅲ AEG, the LNM rates of No.1, 2, 1&2, 3, 4, 7 lymph nodes were ≥20%, LNM rate of No.11p lymph nodes was 10%–20%, LNM rates of No.4sa,4sb, 4d, 8a, 9, 10, 11(11p+11d), 11d lymph nodes were 5%–10%, and the rest were <5%. No matter Siewert Ⅱ and(or)Ⅲ AEG patients, the rates of LNM in No.5, 6, and 12a lymph nodes were <5%. The tumor diameter ≥2 cm and higher T stage(T2–T4) increased the probability of LNM in AEG(P<0.05). Conclusions The results of this meta-analysis combined with the literature suggest that in clinical practice, No.10 lymph node dissection is not necessary for Siewert Ⅱand Siewert Ⅲ AEG patients with tumor length diameter <2 cm and T1 of tumor invasion. No matter Siewert Ⅱ or ⅢAEG, as long as the tumor length diameter <2 cm and T1 of tumor invasion, the distal perigastric lymph nodes(No.4d, 5,6) may not be dissected;Siewert type Ⅱ or Ⅲ AEG patients don’t need to clean No.12a lymph nodes.