Proximal gastric cancer： lymph node metastatic patterns according to different T stages dictate surgical approach

作     者：Song Wu Liu Yuyi Ye Jinning Peng Jianjun He Weiling Chen Jianhui Chen Chuangqi He Yulong 

作者机构：Department of Gastrointestinal Surgery First Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510080 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2014年第127卷第23期

页      面：4049-4054页

核心收录：

学科分类：0710[理学-生物学] 090602[农学-预防兽医学] 1002[医学-临床医学] 07[理学] 09[农学] 0906[农学-兽医学] 071007[理学-遗传学] 

基　　金：This work was supported by grants from Science and Technology Development Project of Guangdong Province （No. 2011B031800240  No. 2012B031800389）  Natural Science Foundation of Guangdong （No. S2013010015528）. 

主　　题：proximal gastric cancer lymph node metastasis surgical approach 

摘      要：Background As a common form of gastric cancer migration,lymph node metastasis largely affects the surgical treatment and prognosis of gastric cancer.Surgery is the fundamental curative option for gastric cancer that varies depending on different stages.The study aimed to compare the clinicopathological characteristics and lymph node metastatic patterns in patients of proximal gastric cancer with different T stages and investigate a reasonable radical gastrectomy approach in terms of the range of lymphadenectomy for proximal gastric cancer.Methods In our retrospective study,the data of 328 patients of proximal gastric cancer with different T stages were analyzed.By comparing the differences of lymph node metastatic rate and ratio,we investigated the clinicopathological characteristics and metastatic patterns of lymph nodes.Also,we were especially interested in the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage.Results The overall lymph node metastatic rate and ratio of advanced proximal gastric cancer were 73.4％ and 23.3％,respectively.The tumors of different T stages were statistically significant in size and differentiation degree （P 0.05）,multivariate analysis showed that the depth of tumor invasion was an independent risk factor for lymph node metastasis in proximal gastric cancer （RR,12.025; 95％ CI,2.326 to 62.157; P=0.003）.The overall survival rate of patients with No.5,6 group lymph node metastasis and those without was significantly different,but the differences in survival rates between patients with and without No.5 and 6 group metastasis with the same TNM stage were not statistically significant.Conclusions Different T stages in proximal gastric cancer showed different patterns and characteristics of lymph node metastasis.D2 lymphadenectomy in patients with early gastric cancer had little survival benefit because metastasis to level 2 nodes was rare.Therefore the range of the lymph node dissection in radical gastrectomy for earty gastric cancer was considered reasonable.Moreover,to meet the requirements of the lymph node dissection,total gastrectomy plus D2 lymphadenectomy or more are supposed to be applied for the advanced proximal gastric cancer patients.Precise T staging larqely determines the range of gastrectomy and lymphadenectomy.