胃癌新辅助化疗对转移性淋巴结的治疗效果分析

目的评价胃癌新辅助化疔对转移性淋巴结的治疗效果。方法选择新疆喀什地区第一人民医院肿瘤外二科2008年3月-2012年12月收治的96例胃癌患者，随机分为常规手术组（48例）和新辅助化疗后手术组（48例），行CT等检查评估临床分期，新辅助化疗后手术组术前行3个周期新辅助化疗，两组均行D2胃癌根治术（第二站淋巴结全部清除）。根据两组术后常规淋巴结病理学检查比较治疗效果。结果胃体部癌及胃食管结合部癌包括中晚期胃体部癌及胃食管结合部癌（ⅢB、ⅢC期及Ⅳ期）新辅助化疗后手术组的术后淋巴结阳性率明显低于常规手术组（胃食管结合部癌进展期：新辅助化疗组淋巴结阳性率10．0％；常规手术组淋巴结阳性率24．8％；胃食管结合部癌晚期：新辅助化疗组淋巴结阳性率12．5％；常规手术组淋巴结阳性率37．1％；胃体部癌进展期：新辅助化疗组淋巴结阳性率8．0％；常规手术组淋巴结阳性率20．5％；胃体部癌晚期：新辅助化疗组淋巴结阳性率3．8％；常规手术组淋巴结阳性率29．8％；达到降低临床期和手术根治；胃窦癌包括中晚期胃窦癌（ⅢB、ⅢC期及Ⅳ期）新辅助化疗后手术组的术后淋巴结阳性率与常规手术组比较差异无统计学意义。结论新辅助化疗对于胃体部癌及胃食管结合部癌的患者，可以达到降低临床分期，减少阳性淋巴结数量，从而达到减少淋巴结癌肿残留、降低局部复发率，使患者生存期延长成为可能，值得推广应用；而胃窦癌新辅助化疗需进一步研究。

The evaluation on the effect of neoadjuvant chemotherapy on metastatic lymph nodes in gastric cancer

Objective The study is to evaluate the effect of neoadjuvant chemotherapy on metastatic lymph nodes in gastric cancer by retrospective analysis method. Methods 96 cases of gastric cancer from March 2008 to December 2012 in the Departement of Tumor Surgery in The First PeoplePs Hospital of Kashi were selected. The patients were divided equally into conventional surgery group and new adjuvant chemothera- py group. The implementation of CT examination after admission was conducted to assess ges. The new adjuvant chemotherapy group was given 3 cycles of chemotherapy before the groups were doing D2-radical gastrectomy for gastrie cancer. The routine pathological e the clinical sta- operation. Both xamination was made after surgery to compare and evaluate the effect of treatment. Results The positive rate of lymph node in gastric cancer in the new adjuvant chemotherapy group is lower than that of the conventional sur- gery group （The positive rate of lymph node in neoadjuvant chemotherapy group was 10%, 12.5%, 80% and 3.8% in various gastric cancer phases while the positive rate of lymph node in conventional surgery group was 24.8%, 37. 1%, 20.5% and 29.8% in contrast. ） There was no statistically significant differ ence between the conventional surgery group and the neoadjuvant chemotherapy group in terminal gastric antrum cancer, including phase IIIB, IIIC and phase IV. Conclusion For gastric cancer and gastroesopha- geal junction adenocarcinoma, neoadjuvant chemotherapy could reduce clinical staging, and the number of positive lymph nodes, therefore, to decrease the likelihood of residual cancer and the recurrence of the dis- ease, and make it possible to extend the patient＇s survival time. The neoadjuvant chemotherapy is a treat- ment worthy of wide application. However, the neoadiuvant chemotherapy on gastric antrum cancer needs further research.