Influencing factors and clinical significance of metastatic lymph node staging in advanced gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigative the influencing factors of metastatic lymph node staging (N staging), and the effect of number of lymph node dissection on the prognosis in advanced gastric carcinoma.</p><p><b>METHODS</b>Clinicopathological data of 395 advanced gastric cancer patients undergoing radical operation in Harbin Medical University Cancer Hospital in 2011 were retrospectively analyzed. Logistic regression was used to investigate the influencing factors. Cox model was used to evaluate the prognostic factors. Association of survival with the number of lymph node dissection in different N stage was further examined.</p><p><b>RESULTS</b>Lymph node metastasis was found in 307 patients(77.7%), including 88 of N0, 86 of N1, 111 of N2 and 110 of N3. Overall 3-year survival rate was 65.3%. Borrmann classification (χ(2)=32.045, P=0.000), histopathological type (χ(2)=5.595, P=0.018), depth of invasion (χ(2)=27.227, P=0.000) and the number of lymph node dissection (χ(2)=12.337, P=0.000) were influencing factors of metastatic lymph node. Tumor location(OR=2.86, 95% CI: 1.80~4.53, P=0.000), depth of invasion (OR=1.44, 95% CI: 1.12~1.85, P=0.004) and the number of metastatic lymph node (OR=1.58, 95% CI: 1.33~1.87, P=0.000) were independent prognostic factors(all P < 0.05), and number of lymph node dissection was not associated with prognosis (P > 0.05). Subgroup analysis revealed overall survival rate of stage N3 patients with ≥ 40 of lymph node dissection was obviously higher as compared to those with < 40, while such difference was not found in N0, N1, N2 groups (all P > 0.05).</p><p><b>CONCLUSIONS</b>Lymph node staging of advanced gastric cancer is associated with Borrmann classification, histopathological type, depth of invasion and number of lymph node dissection. Dissection of 20 lymph nodes is suitable for stage N0, N1 and N2, while ≥ 40 lymph nodes should be dissected in stage N3.</p>

Analysis of clinicopathological features and prognosis in patients with advanced gastric cancer in different locations / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the differences of clinicopathological features and prognosis in patients with advanced gastric cancer in different locations after radical gastrectomy, and to provide optimized therapies.</p><p><b>METHODS</b>Clinicopathological data of 421 patients with advanced gastric cancer undergoing radical gastrectomy in our department from January to December 2011 were analyzed retrospectively. Patients were divided into 3 groups according to cancer locations, including 48 cases of upper gastric cancer, 74 cases of middle gastric cancer and 299 cases of lower gastric cancer. Clinicopathological features and prognosis were compared among groups.</p><p><b>RESULTS</b>There were significant differences among 3 groups in lesion size(P=0.001), subtypes(P=0.033), pT classification(P=0.010), TNM staging(P=0.019) and lymph node metastasis (P=0.000). Ratio of lesion size >5 cm, and T4, N3, stage III( patients was significantly higher in upper gastric cancer group as compared to middle and lower group (all P<0.05). The survival curves showed that the general prognosis of upper gastric cancer group was worse than that of middle and lower gastric cancer group (P<0.05), while no significant difference was found between middle and lower gastric cancer group (P=0.027). Multivariate analysis revealed that depth of invasion (P=0.034, HR=1.918) was independent prognostic factor of advanced upper gastric cancer, lymph node metastasis (P=0.022, HR=1.406) was independent prognostic factor of advanced middle gastric cancer, and depth of invasion (P=0.022, HR=1.359) and lymph node metastasis (P=0.000, HR=1.519) were independent prognostic factors of advanced lower gastric cancer.</p><p><b>CONCLUSION</b>As compared to advanced middle and lower gastric cancer, advanced upper gastric cancer possesses bigger cancer lesion, deeper depth of invasion, easier metastasis of lymph nodes, later TNM staging, and worse prognosis.</p>