Objective:The current standard D2 lymphadenectomy for gastric cancer(GC)includes dissection of lymph nodes(LNs)along the proper hepatic artery(No.12 a),however,the survival benefit remains controversial.The purpose of...Objective:The current standard D2 lymphadenectomy for gastric cancer(GC)includes dissection of lymph nodes(LNs)along the proper hepatic artery(No.12 a),however,the survival benefit remains controversial.The purpose of this study was to evaluate the pattern of No.12 a LN metastasis(LNM)in GC and explore the indications for No.12 a LN dissection.Methods:Medical records of 413 consecutive GC patients who underwent curative surgery in Zhongshan Hospital,Fudan University between January 2015 and December 2018 were enrolled and reviewed retrospectively.The correlation between No.12 a LNM and clinicopathologic characteristics of patients was analyzed.Results:The overall incidence of No.12 a LNM was 2.67%(11/413).Tumor location(P=0.012),depth of tumor infiltration(P<0.01)and N stage(P=0.018)were significant factors associated with No.12 a LNM.All the tumors with No.12 a LNM involved the lower third of the stomach and were in T3-4 stages.Patients with No.12 a LNM had extensive LNM than those without(20.91±4.25 vs.5.0±0.54,P<0.001).For advanced GC patients(stage III/IV)with tumors involving the lower third of the stomach,the incidence of No.12 a LNM increased to 10.7%(11/103).Patients with No.12 a LNM had a significantly poorer recurrence-free survival(RFS)(P=0.005)and overall survival(OS)(P=0.017).According to the result of multivariable Cox regression,No.12 a LNM was not an independent impact factor on RFS and OS.Conclusions:The overall incidence of No.12 a LNM was low but it was much higher in GC patients who had very advanced tumors involving the lower third of the stomach.No.12 a LN dissection should be considered for these patients to improve the survival outcomes.展开更多
BACKGROUND Controversy over the issue that No.12a lymph node involvement is distant or regional metastasis remains,and the possible inclusion of 12a lymph nodes in D2 lymphadenectomy is unclear.As reported,gastric can...BACKGROUND Controversy over the issue that No.12a lymph node involvement is distant or regional metastasis remains,and the possible inclusion of 12a lymph nodes in D2 lymphadenectomy is unclear.As reported,gastric cancer(GC)located in the lower third is highly related to the metastasis of station 12a lymph nodes.AIM To investigate whether the clinicopathological factors and metastasis status of other perigastric nodes can predict station 12a lymph node metastasis and evaluate the prognostic significance of station 12a lymph node dissection in patients with lower-third GC.METHODS A total of 147 patients with lower-third GC who underwent D2 or D2+lymphadenectomy,including station 12a lymph node dissection,were included in this retrospective study from June 2003 to March 2011.Survival prognoses were compared between patients with or without station 12a lymph node metastasis.Logistic regression analyses were used to clarify the association between station 12a lymph node metastasis and clinicopathological factors or metastasis status of other perigastric nodes.The metastasis status of each regional lymph node was evaluated to identify the possible predictors of station 12a lymph node metastasis.RESULTS Metastasis to station 12a lymph nodes was observed in 18 patients with lowerthird GC,but not in 129 patients.The incidence of station 12a lymph node involvement was reported as 12.2%in patients with lower-third GC.The overall survival of patients without station 12a lymph node metastasis was significantly better than that of patients with station 12a metastasis(P<0.001),which could also be seen in patients with or without extranodal soft tissue invasion.Station 12a lymph node metastasis and extranodal soft tissue invasion were identified as independent predictors of poor prognosis in patients with lower-third GC.Advanced pN stage was defined as independent risk factor significantly correlated with station 12a lymph node positivity.Station 3 lymph node staus was also proven to be significantly correlated with station 12a lymph node involvement.CONCLUSION Metastasis of station 12a lymph nodes could be considered an independent prognosis factor for patients with lower-third GC.The dissection of station 12a lymph nodes may not be ignored in D2 or D2+lymphadenectomy due to difficulties in predicting station 12a lymph node metastasis.展开更多
基金supported by National Natural Science Fund(No.31842033)。
文摘Objective:The current standard D2 lymphadenectomy for gastric cancer(GC)includes dissection of lymph nodes(LNs)along the proper hepatic artery(No.12 a),however,the survival benefit remains controversial.The purpose of this study was to evaluate the pattern of No.12 a LN metastasis(LNM)in GC and explore the indications for No.12 a LN dissection.Methods:Medical records of 413 consecutive GC patients who underwent curative surgery in Zhongshan Hospital,Fudan University between January 2015 and December 2018 were enrolled and reviewed retrospectively.The correlation between No.12 a LNM and clinicopathologic characteristics of patients was analyzed.Results:The overall incidence of No.12 a LNM was 2.67%(11/413).Tumor location(P=0.012),depth of tumor infiltration(P<0.01)and N stage(P=0.018)were significant factors associated with No.12 a LNM.All the tumors with No.12 a LNM involved the lower third of the stomach and were in T3-4 stages.Patients with No.12 a LNM had extensive LNM than those without(20.91±4.25 vs.5.0±0.54,P<0.001).For advanced GC patients(stage III/IV)with tumors involving the lower third of the stomach,the incidence of No.12 a LNM increased to 10.7%(11/103).Patients with No.12 a LNM had a significantly poorer recurrence-free survival(RFS)(P=0.005)and overall survival(OS)(P=0.017).According to the result of multivariable Cox regression,No.12 a LNM was not an independent impact factor on RFS and OS.Conclusions:The overall incidence of No.12 a LNM was low but it was much higher in GC patients who had very advanced tumors involving the lower third of the stomach.No.12 a LN dissection should be considered for these patients to improve the survival outcomes.
文摘BACKGROUND Controversy over the issue that No.12a lymph node involvement is distant or regional metastasis remains,and the possible inclusion of 12a lymph nodes in D2 lymphadenectomy is unclear.As reported,gastric cancer(GC)located in the lower third is highly related to the metastasis of station 12a lymph nodes.AIM To investigate whether the clinicopathological factors and metastasis status of other perigastric nodes can predict station 12a lymph node metastasis and evaluate the prognostic significance of station 12a lymph node dissection in patients with lower-third GC.METHODS A total of 147 patients with lower-third GC who underwent D2 or D2+lymphadenectomy,including station 12a lymph node dissection,were included in this retrospective study from June 2003 to March 2011.Survival prognoses were compared between patients with or without station 12a lymph node metastasis.Logistic regression analyses were used to clarify the association between station 12a lymph node metastasis and clinicopathological factors or metastasis status of other perigastric nodes.The metastasis status of each regional lymph node was evaluated to identify the possible predictors of station 12a lymph node metastasis.RESULTS Metastasis to station 12a lymph nodes was observed in 18 patients with lowerthird GC,but not in 129 patients.The incidence of station 12a lymph node involvement was reported as 12.2%in patients with lower-third GC.The overall survival of patients without station 12a lymph node metastasis was significantly better than that of patients with station 12a metastasis(P<0.001),which could also be seen in patients with or without extranodal soft tissue invasion.Station 12a lymph node metastasis and extranodal soft tissue invasion were identified as independent predictors of poor prognosis in patients with lower-third GC.Advanced pN stage was defined as independent risk factor significantly correlated with station 12a lymph node positivity.Station 3 lymph node staus was also proven to be significantly correlated with station 12a lymph node involvement.CONCLUSION Metastasis of station 12a lymph nodes could be considered an independent prognosis factor for patients with lower-third GC.The dissection of station 12a lymph nodes may not be ignored in D2 or D2+lymphadenectomy due to difficulties in predicting station 12a lymph node metastasis.
