胃癌淋巴结转移个数与胃癌预后的关系

目的:探讨胃癌患者胃周淋巴结转移个数与预后以及有关临床资料之间的关系。方法:回顾性分析261例获术后随访的胃癌,分析胃周淋巴结转移阳性的个数与预后以及病理参数之间的关系。结果:全组5年生存率39.1％;阳性淋巴结个数为0.1～5、>5个时5年生存率为73.8％、37.7％、15.6％(P<0.0001),5年生存率随着转移淋巴结的个数增多而呈下降趋势。转移淋巴结的个数亦与肿瘤的大小、组织学类型、浸润的深度有明显有相关关系。结论:胃癌转移淋巴结个数与术后预后有相关关系,其可作为胃癌术后预后的简单、有效的指标。但不适用姑息性胃癌切除者。     

淋巴结转移在胃癌预后中的评价

淋巴结转移为胃癌最常见的转移方式,是影响胃癌预后的重要原因之一,基于淋巴结转移数目和解剖位置的胃癌淋巴结转移分期(N分期)是最常见的预后评估和诊断分期方式,围绕N分期的研究至今仍在不断进行优化完善。许多特殊类型的淋巴结转移也逐渐被认识,如癌结节、淋巴结微转移、孤立肿瘤细胞及跳跃性转移。此文从淋巴结转移的机制、淋巴结转移分期演变、特殊淋巴结转移类型进行综合探讨淋巴结转移如何影响胃癌预后的评估。     

淋巴结比率在淋巴结阳性阴茎癌预后中的价值

目的探讨淋巴结比率在淋巴结阳性阴茎癌中的预后价值。方法分析1990年至2008年间复旦大学附属肿瘤医院诊治的60例淋巴结转移性阴茎鳞状细胞癌患者的临床资料。所有患者均接受了区域淋巴结清扫手术。阳性淋巴结数和淋巴结比率都转化为分类变量加以分析。无复发生存曲线通过Kaplan-Meier方法绘制并通过Log-rank检验加以分析。结果本组患者的阳性淋巴结数中位数为2个（1～27）,淋巴结比率的中位数为0.0896（0.031～0.406）。随着淋巴结清扫总数的增多,阳性淋巴结数目也逐渐增多。Log-rank成对比较的结果显示淋巴结比率比阳性淋巴结数能更好地区分各组间的生存差异。结论淋巴结比率是比阳性淋巴结数目更好的预后指标,更进一步的大宗病例研究有助于确定淋巴结比率的界值来具体界定低危和高危患者。     

淋巴结转移比率在预测淋巴结转移乳腺癌患者预后中的价值

目的探讨淋巴结转移比率(MLNR)在预测淋巴结转移乳腺癌患者预后中的应用价值。方法回顾性分析94例接受改良根治术治疗的淋巴结转移乳腺癌患者的临床资料,并对患者生存情况及影响预后的相关因素进行分析。结果 94例患者随访时间为12~75个月,中位随访时间为64个月,5年生存率为72.34%(68/94)。总MLNR为0.31(486/1 553)。单因素分析显示原发肿瘤大小、淋巴结转移数目、ER状态、放疗与否和MLNR影响淋巴结转移乳腺癌患者的预后(P<0.05),而患者年龄、绝经与否、PR状态、内分泌治疗与否和组织学类型与预后无关(P>0.05)。多因素分析发现MLNR(OR=2.565,95%CI=1.043~6.309,P=0.040)和肿瘤大小(OR=2.220,95%CI=1.045~4.716,P=0.038)是影响淋巴结转移乳腺癌患者预后的独立因素。结论 MLNR是影响淋巴结转移乳腺癌患者的独立预后因素,且其预测效果比淋巴结转移数目更为准确和客观。     

胃周转移淋巴结数对胃癌患者预后评估的价值

目的寻找适用于胃癌术后患者预后比较的简单指标。方法选取1999-2005年间在复旦大学附属中山医院胃肿瘤组接受根治性手术治疗的148例患者的病例资料进行总结,分析胃周淋巴结转移情况及其与患者预后的关系。结果148例患者3年累计总生存率为62．8％,生存率随胃周转移淋巴结数增加而下降。当胃周转移淋巴结数超过6枚时,3年生存率降至15．4％,与全组3年总生存率比较,差异有统计学意义（P〈0．01）。胃周转移淋巴结数与总阳性淋巴结数存在线性关系（r=0．94,P〈0．01）,但与总切除淋巴结数不存在线性关系（r=0．18,P=0．2）。结论胃周转移淋巴结是一个简单有效判断胃癌术后患者预后的指标。胃周转移淋巴结对淋巴结切除技术要求低,可用于比较不同地区间胃癌术后患者的预后。     

进展期胃癌腹主动脉旁淋巴结微小转移与患者预后的关系

目的研究进展期胃癌腹主动脉旁淋巴结的微小转移对于评价预防性淋巴结清除的意义。方法采用细胞角蛋白抗体,对47例进展期胃癌患者根治性手术清除的2339枚淋巴结(其中包括390枚腹主动旁淋巴结),进行免疫组织化学染色研究。结果常规HE染色发现390枚腹主动脉旁淋巴结中,95枚从14例患者中清除的淋巴结为转移阳性。剩余的295枚淋巴结中,有45枚从另15例患者中清除的淋巴结经免疫组化染色发现有微小转移。术后5年生存率在腹主动脉旁淋巴结转移阴性组为56．0％,微小转移组为25．2％,常规染色淋巴结转移组为9．0％。结论进展期胃癌存在较高的腹主动脉旁淋巴结微小转移率,预防性淋巴结清除对此类患者有效。     

胃癌淋巴结转移研究新进展

淋巴结转移是胃癌的一个重要的生物学特性 ,日本学者认为扩大淋巴结清扫可显著改善患者的预后 ,并把Ｄ2 根治术作为胃癌的标准术式。西方学者认为淋巴结清扫对改善预后并无帮助 ,它仅能用于判断预后[1] 。两种观点争论不休 ,大量临床资料证实大范围的淋巴结清扫的确在某种程度上能够改善患者的预后 ,但同时也增加了并发症和死亡率 ,所以如何在术前术中了解淋巴结的状态 ,指导手术范围 ,术后依据淋巴结病理结果判断预后 ,都是国内外学者孜孜不倦研究的课题。1　胃癌淋巴结转移规律胃的淋巴引流是从胃的初级淋巴结逐步流向中间淋巴结(包括第二…     

淋巴结转移对无浆膜浸润胃癌患者预后的影响

目的 探讨淋巴结转移对无浆膜浸润胃癌预后的影响.方法 回顾性分析1994年1月至2005年12月间大连医科大学附属第一医院普通外科行D2或D2以上胃癌根治术、且具有完整随访资料的616例无浆膜浸润胃癌患者的临床资料;并选取同期接受相同术式的有浆膜浸润的162例胃癌患者为对照组.结果 无浆膜浸润胃癌患者的5年生存率为77.9％,明显高于浆膜浸润组的37.3％（P＜0.01）.不同浸润深度患者5年生存率分别为T１a（M）95.6％,T1b（SM） 92.5％,T2（MP）73.5％,T3（SS） 62.7％,T4（SE、SI） 37.3％.按日本第13版《胃癌处理规约》,N0、N1（第1站）、N2（第2站）和N3（第3站）无浆膜浸润胃癌患者的5年生存率分别为91.5％、75.3％、54.8％和14.7％,差异有统计学意义（P＜0.01）;按第7版TNM分期,N0、N1（1～2枚）、N2（3～6枚）、N3a（7～15枚）和N3b（15枚以上）无浆膜浸润胃癌患者的5年生存率分别为91.5％、83.6％、59.8％、17.2％和11.8％,差异亦有统计学意义（P＜0.01）.淋巴结转移是无浆膜浸润胃癌患者预后的独立预后因素（P＜0.0l）.结论 无论是按转移淋巴结的范围还是数量进行评价,淋巴结转移均能对无浆膜浸润胃癌患者的预后作出较好的预测.     

胃癌淋巴结转移规律的研究现状

本文综述了胃癌淋巴结转移规律的临床研究现状，分析了胃癌淋巴结的转移率与诸多因素的关系，包括肿瘤浸润深度、大体形态、大小、组织分型、肿瘤发生部位、患者年龄、性别等，探究了肿瘤的部位和转移淋巴结的组群分布关系。     

近端胃癌手术时淋巴结清扫范围、数目及转移的研究

目的研究近端胃癌手术时淋巴结切除范围、数目、转移和预后的关系。方法 行D2或D3术式的近端胃癌标本，全数摘取淋巴结，比较全胃切除和近端胃切除的淋巴结切除数目并判断预后。结果 本组31例共取淋巴结1971枚，平均63枚／例。近端胃切除57枚／例，全胃切除71枚／例，左半胰切除64枚／例，保留左半胰63枚／例。新分期N1、N2、N35年生存率分别为36％、11％、0。结论 随着癌肿侵犯范围扩大，必须扩大淋巴结切除范围；保留左半胰不影响淋巴结切除数目；新的定量N分期在评价预后方面优于旧的定性N分期。     

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目的 分析进展期胃癌胃周淋巴结转移及淋巴结清除与病人预后的关系。方法 对1982－1992年间收治并行手术治疗的进展期胃癌299例进行统计分析。结果 肿瘤进展与淋巴结转移的程度显著相关（P＜0.05）。淋巴结转移有无、淋巴结清扫与术后生存直接相关，对于侵及浆膜下或侵出浆膜并伴有远处淋巴结转移的病例，淋巴结清扫仍能提高术后生存率（P＜0.05）。结论 严格的淋巴结清扫可以提高胃癌病人术后生存率。     

Impact of metastatic lymph node ratio in node-positive colorectal cancer

Colorectal cancer (CRC) is one of the most common malignant diseases in the world. Presently, the most widely used staging system for CRC is the tumor nodes metastasis classification system, which classifies patients into prognostic groups according to the depth of the primary tumor, presence of regional lymph node (LN) metastases, and evidence of distant metastatic spread. The number of LNs with confirmed metastasis is related to the severity of the disease, but this number depends on the number of LNs retrieved, which varies depending on patient age, tumor grade, surgical extent, and tumor site. Numerous studies and a recent structured review have demonstrated associated improvements in the survival of CRC patients with increasing numbers of LNs retrieved for examination. Hence, the impact of lymph node ratio (LNR), defined as the number of metastatic LNs divided by the number of LNs retrieved, has been investigated in various malignancies, including CRC. In this editorial, we review the literature demonstrating the clinicopathological significance of LNR in CRC patients. Some reports have indicated the advantage of considering the LNR compared to the number of LNs retrieved and/or LN status. When the LNR is taken into consideration for survival analysis, the number of LNs retrieved and/or the LN status is not always found to be a prognostic factor. The cut-off points for LNRs were proposed in numerous studies. However, optimal thresholds for LNRs have not yet received consensus. It is still unclear whether the LNR has more prognostic validity than N stage. For all these reasons, the potential advantages of LNRs in the staging system should be investigated in large prospective data sets.     

早期胃癌淋巴结转移相关因素分析

目的 探讨早期胃癌病人临床病理特征及免疫病理与淋巴结转移的相关性。方法 对2006年1月至2008年l2月第二军医大学长海医院普通外科诊治的212例早期胃癌病例进行回顾性分析,采用t检验、χ2检验和Logistic回归等统计学方法对肿瘤大小、浸润深度、组织学类型等临床病理特征以及p53、Ki?67、CAM5.2等免疫组化指标与淋巴结转移进行相关性分析。结果 肿瘤大体类型、大小、浸润深度、组织分化程度与淋巴结转移存在明显的相关性（P值为0.014、0.001,0.012,0.006,相关系数R为2.213、1.779、4.737、4.15）。免疫病理指标中p53、CAM5.2与淋巴结转移也存在明显相关（P值为0.001和0.000,相关系数R为1.922、3.632）。而年龄、性别、肿瘤位置、多发肿瘤及免疫病理指标中p16、TopoⅡ、Ki?67与淋巴结转移无明显相关性。结论 早期胃癌淋巴结转移与肿瘤大小、肿瘤分化程度、浸润深度等明显相关,可参考上述因素判断淋巴结转移风险,同时根据免疫病理指标CAM5.2、P53判断是否存在微转移可能,从而决定治疗方案。     

胃癌前哨淋巴结研究进展

前哨淋巴结是从原发肿瘤淋巴引流途中首先可能发生转移的部位。Cabana在阴茎癌中提出前哨淋巴结的概念后,前哨淋巴结活检技术不断在多种肿瘤中广泛应用。目前,该技术已成功用于黑色素瘤、乳腺癌等手术。但在胃癌中,由于胃淋巴引流复杂、存在跳跃转移以及假阴性率较高,前哨淋巴结活检技术应用于临床还为时过早,其可行性和适用性尚无定论。因此,前哨淋巴结活检技术应用于胃癌,还有许多问题需要回答。     

Role of lymph node density in predicting survival of patients with lymph node metastases after radical cystectomy: A multi-institutional study

Objectives:   To evaluate the prognostic role of different clinico-pathological parameters in node-positive patients treated by radical cystectomy.
Methods:   A retrospective multi-institutional study of 435 patients who underwent radical cystectomy between 1990 and 2005 was carried out. Of them, pathological lymph node (LN) metastases were found in 83 patients. Sixty of these 83 patients, whose clinical information and follow-up data were available, were included in the analysis. Twenty-five patients had undergone adjuvant chemotherapy, whereas 35 had not. A Cox proportional hazards model was used to determine the impact of the following clinico-pathological parameters on patient survival: number of resected LNs, number of positive LNs, LN density (defined as the ratio of the number of positive LNs divided by the total number of resected LNs) and adjuvant chemotherapy.
Results:   Median follow-up for surviving patients was 41 months (range 4–138) after surgery. The median survival time for all patients was 22 months (95% confidence interval, 15–42 months). At multivariate analysis, LN density of 25% or less, adjuvant chemotherapy and pure urothelial carcinoma were independently significant predictors of survival.
Conclusions:   Lymph node density predicts survival in patients with node-positive bladder cancer.     

The macroscopic diagnosis of lymph node metastasis from early gastric cancer

As the proportion of early gastric cancers (EGC) has been steadily increasing, modifications of the radical lymphadenectomy approach to stomach cancer have been attracting considerable attention; however, accurate pre- and intraoperative evaluations of tumor extent are essential for the successful application of this method. We examined the reliability of macroscopically diagnosing node involvement by reviewing the operative and pathological records of 522 patients with EGC. Of 59 patients histologically diagnosed as node-positive (n+), only 19 (32%) had been macroscopically diagnosed as node-positive (N+). In contrast, of 61 N+ patients, 42 (69 %) were in fact n-. Metastases from histologically diffuse type carcinomas were less accurately diagnosed than those from intestinal type tumors. In 44% of the false-positive (N+/n-) patients, the tumor had been preoperatively diagnosed as advanced, which seemed to have lead to intraoperative overdiagnosis. These results suggest that lymph node metastases from EGC cannot be reliably diagnosed during surgery. The indications for a modified radical operation should thus be decided according to preoperative tumor evaluation based on the depth of invasion.     

淋巴结转移率对胃癌患者预后的评估价值

目的 评估淋巴结转移率(MLR)对胃癌患者预后的预测价值.方法 回顾性分析2005-2009年间在南京医科大学第一附属医院接受根治性切除(pT4期患者除外)并具有完整随访资料的1247例胃癌患者的临床资料,从准确性、均一性和适用性3个方面比较MLR分期和pN分期的预后价值.结果 MLR和pN均与送检淋巴结数目呈正相关(均P<0.01).不同MLR分期及不同pN分期患者5年累计生存率(5-YCSR)的差异均有统计学意义(均P<0.01);进一步经多因素预后分析显示,MLR分期和pN分期均可作为独立的预后因素(均P<0.01).ROC曲线显示,MLR分期预测预后所对应的曲线下面积大于pN分期,但差异并未达到统计学意义(p>0.05).相同MLR组中不同pN组间5-YCSR的差异无统计学意义(P>0.05);而相同pN组中不同MLR组间5-YCSR的差异有统计学意义(P<0.05).同一pN分期患者,送检淋巴结数目不同,其5-YCSR的差异均有统计学意义(P<0.05);而同一MLR分期患者5-YCSR则与送检淋巴结数目无关(P>0.05).结论 MLR是预测胃癌生存的独立预后因素;MLR分期评估胃癌预后的准确性与pN分期相当,但均一性和适用性均优于pN分期.

Abstract：

Objective To evaluate the prognostic value of metastatic lymph node ratio (MLR) for patients with gastric cancer. Methods Data collected from 1247 patients with gastric cancer who underwent radical surgery (pT4 cases were excluded) at the First Affiliated Hospital of Nanjing Medical University between 2005 and 2009 were analyzed retrospectively. MLR was compared to pathological N staging (pN) in terms of prognostic accuracy, homogenicity, and applicability. Results MLR and pN were both positively correlated with the number of retrieved lymph nodes (both P<0.01). Significant differences were found in 5-year cumulative survival rate (5-YCSR) among different pN stages and MLR classification (all P<0.01). Multivariable analysis showed that both pN and MLR were independent prognostic factors (both P<0.01). The area under ROC curve (AUC) of MLR was larger than pN, however the difference was not statistically significant (P>0.05). There were significant differences in 5-YCSR among different MLR stages within the same pN stages (P<0.05), but not among different pN stages within the same MLR stage (P>0.05). Significant differences in 5-YCSR were also found among different retrieved-node groups within the same pN stage (P<0.05), but not within the same MLR stages (P>0.05). Conclusions MLR is an independent prognostic factor for patients with gastric cancer. The prognostic homogenicity and applicability of MLR are better than those of pN, however the prediction accuracy is not favorable.     

早期胃癌淋巴结转移的危险因素分析

目的探讨早期胃癌病人淋巴结转移的危险因素,以期为临床治疗方案的选择提供依据。方法回顾性分析我院2010年1月至2013年12月期间收治的早期胃癌病人的临床病理特征与淋巴结转移规律关系。结果共89例早期胃癌病人纳入研究分析,所有病人淋巴结转移率为14.6%(13/89)。肿瘤大体类型分为隆起型、表浅型、凹陷型,其淋巴结转移率分别为10.0%、5.6%及22.0%,各型间淋巴结转移率差异有统计学意义(P =0.000);黏膜内癌与黏膜下癌淋巴结转移率分别为4.9%(2/41)及22.9%(11/48),二者间差异有统计学意义(P =0.016);高分化良好型早期胃癌无淋巴结转移,中分化及低分化早期胃癌淋巴结转移分别为10.3%(3/29)、18.5%(10/54),差异有统计学意义(P =0.000);6例病人伴有脉管癌栓,其中4例发生淋巴结转移。Logistic 回归多因素分析结果显示：肿瘤大体类型、分化程度、浸润深度及脉管癌栓对淋巴结转移具有显著性影响(P <0.05),其比值比(OR)值分别为4.7、3.2、15.1和5.7。病人性别、年龄、肿瘤部位等与淋巴结转移无相关性。结论早期胃癌病人淋巴结转移率低,其转移与否同肿瘤大体类型、浸润深度、分化程度以及脉管癌栓密切相关。     

Does the extent of lymph node dissection affect the postoperative survival of patients with gastric cancer and disseminating peritoneal metastasis?

For patients with gastric cancer and either P, or P₂ peritoneal metastasis, no definite consistent policy with respect to the extent of lymph node dissection has yet been established. In palliatively gastrectomized patients, we analyzed the relationship between the extent of lymphadenectomy and postoperative survival. In patients with P₁, an R₂ or R₃ lymphadenectomy was associated with a significantly improved postoperative survival as compared to an Rl dissection, while this, however, was not the case in patients with P₂. As this study was not intended to be a prospective randomized study, a definite conclusion should be avoided. However, our findings suggest that in patients with PI, surgery should not be confined to a resection of the primary lesion, but should also include an R₂ or R₃ lymphadenectomy.