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首页> 美国卫生研究院文献>Journal of Clinical Medicine >Is There Any Role for Super-Extended Limphadenectomy in Advanced Gastric Cancer? Results of an Observational Study from a Western High Volume Center
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Is There Any Role for Super-Extended Limphadenectomy in Advanced Gastric Cancer? Results of an Observational Study from a Western High Volume Center

机译：晚期胃癌超扩展淋巴结清扫术有什么作用？西部高容量中心的观测研究结果

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Background: Although the Japan Clinical Oncology Group (JCOG) 9501 trial did not find that prophylactic D3 lymphadenectomy led to any survival advantage over D2 lymphadenectomy, it did find that the prognosis of subserosal and N0 gastric cancer patients improved. The aim of this retrospective observational study was to compare survival after D2 or D3 lymphadenectomy in different patient subgroups. Methods: The study considered all of the patients who underwent D2 or D3 lymphadenectomy at a high-volume center in Verona (Italy) between 1992 and 2011. After excluding patients with Bormann IV or neuroendocrine tumors, early gastric cancers, or non-curative resections, the analysis involved 301 R0 patients: 100 who underwent D2, and 201 who underwent D3 lymphadenectomy. Post-operative deaths and deaths due to recurrences were considered as terminal events in the survival analysis. Results: The D2 patients were significantly older than the D3 patients at baseline (69.8 ± 2.3 vs. 62.2 ± 10.7 years). The median number of retrieved nodes was 29 (interquartile range: 24.5–39) after D2, and 43 (34–52) after D3. The five-year disease-related survival rate was similar after D2 (44%, 95% confidence interval (CI) 34–54%) and D3 (41%, 34–48%) ( = 0.766). A Cox model controlling for sex, age, tumor site, Laurén histology, and T and N stages showed that the risk of cancer-related death after D3 was similar to that recorded after D2 (hazard ratio 0.97, 95% CI 0.67–1.42). There was a significant interaction between the T status and the extension of the lymphadenectomy ( = 0.012), with the prognosis being better after D2 in T2 and T4b patients, and after D3 in T3 patients. Conclusions: The findings of this study suggest that D3 lymphadenectomy is not routinely indicated for patients with advanced gastric cancer, although differences in survival after D3 across T tiers deserve further consideration.
机译：背景：尽管日本临床肿瘤学集团（JCOG）9501试验没有发现预防性D3淋巴结清扫术比D2淋巴结清扫术具有任何生存优势，但确实发现了浆膜下和N0胃癌患者的预后得到了改善。这项回顾性观察研究的目的是比较D2或D3淋巴结清扫术在不同患者亚组中的生存率。方法：该研究纳入了1992年至2011年在维罗纳（意大利）高容量中心接受D2或D3淋巴结清扫术的所有患者。排除了Bormann IV或神经内分泌肿瘤，早期胃癌或非治愈性切除的患者，该分析涉及301名R0患者：100名接受了D2的患者和201名接受了D3的淋巴结清扫术的患者。术后死亡和因复发而死亡被认为是生存分析中的晚期事件。结果：D2患者在基线时显着高于D3患者（69.8±2.3年vs. 62.2±10.7年）。在D2之后，检索到的节点的中位数为29（四分位数范围：24.5–39），在D3之后则为43（34–52）。 D2（44％，95％置信区间（CI）34–54％）和D3（41％，34–48％）（= 0.766）之后，五年疾病相关生存率相似。通过Cox模型控制性别，年龄，肿瘤部位，Lauren组织学以及T和N分期，发现D3之后与癌症相关的死亡风险与D2之后相似（危险比0.97，95％CI 0.67-1.42） 。 T状态与淋巴结清扫术的扩展之间存在显着的相互作用（= 0.012），T2和T4b患者在D2之后和T3患者在D3之后的预后更好。结论：这项研究的结果表明，对于晚期胃癌患者，常规不建议行D3淋巴结清扫术，尽管在T层之间进行D3术后生存率的差异值得进一步考虑。

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