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摘要
目的探讨新辅助治疗对局部进展期胃上部癌D2根治术淋巴结获取的影响。方法采用回顾性队列研究方法。收集2013年1月至2016年9月北京大学肿瘤医院胃肠肿瘤中心收治的319例局部进展期胃上部癌患者的临床病理资料。200例未行新辅助治疗、直接行胃癌D2根治术患者设为直接手术组,88例行新辅助化疗患者设为新辅助化疗组,31例行新辅助放化疗患者设为新辅助放化疗组。观察指标和评价标准:3组患者术后病理学检查情况比较。肿瘤分期参照第8版美国癌症联合会(AJCC)指南。正态分布的计量资料以x±s表示,多组间比较采用方差分析;偏态分布的计量资料以M(范围)表示,多组间比较采用秩和检验,两两比较采用非参数检验。计数资料多组间比较采用精确χ2检验,两两比较采用χ2分割法。结果3组患者术后病理学检查情况比较:直接手术组患者术后病理学T分期中T0期、Tla期、T1b期、T2期、T3期、T4a期、T4b期例数分别为0、2、10、24、99、58、7例,新辅助化疗组分别为5、1、2、11、41、26、2例,新辅助放化疗组分别为5、1、2、8、10、4、1例。直接手术组患者术后病理学N分期中N0期、N1期、N2期、N3a期、N3b期例数分别为56、41、34、47、22例,新辅助化疗组分别为29、17、27、10、5例,新辅助放化疗组分别为18、10、2、1、0例。直接手术组、新辅助化疗组、新辅助放化疗组患者有脉管癌栓分别为124、43、6例,无脉管癌栓分别为76、45、25例;淋巴结检出总数分别为31枚(15～87枚)、30枚(15～62枚)、21枚(15～36枚);淋巴结转移数目分别为3枚(0～39枚)、2枚(0～37枚)、0(0～7枚);淋巴结转移率分别为9.2%(0～91.3%)、7.7%(0～78.7%)、0(0～30.4%)。3组患者术后病理学T分期、术后病理学N分期、脉管癌栓情况、淋巴结检出总数、淋巴结转移数目、淋巴结转移率比较,差异均有统计学意义(χ2=35.799,32.489,21.076,Z=27.120,22.088,16.947,P<0.05)。其中直接手术组与新辅助化疗组患者上述指标比较,差异均无统计学意义(χ2=11.436,12.343,4.295,P>0.05)。直接手术组与新辅助放化疗组患者上述指标比较,差异均有统计学意义(χ2=28.500,20.124,19.570,P<0.05)。新辅助化疗组与新辅助放化疗组患者比较,术后病理学N分期、脉管癌栓情况、淋巴结检出总数、淋巴结转移数目、淋巴结转移率差异均有统计学意义(χ2=14.027,8.313,P<0.05);而术后病理学T分期差异无统计学意义(χ2=11.742,P>0.05)。结论新辅助放化疗可减少局部进展期胃上部癌术后淋巴结检出总数和淋巴结转移数目。【Abstract】Objective To explore the impact of neoadjuvant therapy on the number of harvested lymph nodes in D2 radical resection of the proximal locally advanced gastric cancer(GC).Methods The retrospective cohort study was conducted.The clinicopathological data of 319 patients with proximal locally advanced GC who were admitted to the Beijing Cancer Hospital from January 2013 to September 2016 were collected.Of 319patients,200 underwent D2 radical resection of GC and didn’t undergo neoadjuvant therapy who were divided into the surgery group,88 underwent neoadjuvant chemotherapy into the chemotherapy group,and 31 underwentneoadjuvant chemoradiotherapy into the chemoradiotherapy group.Observation indicators and evaluation criteria:comparison of postoperative pathological results among 3 groups,according to tumor staging guideline of American Joint Committee on Cancer(AJCC)(8th version)Measurement data with normal distribution were represented as x±s,comparisons among groups were analyzed using the ANOVA.Measurement data with skewed distribution were described as M(range),comparisons among groups were analyzed using the ANOVA,and pairwise comparisons were analyzed using nonparametric test.Comparisons of count data among groups were analyzed using the exact chisquare test,and pairwise comparisons were analyzed using the chi-square partition method.Results Comparison of postoperative pathological results among 3 groups:stage TO,T1a,T1b,T2,T3,T4a and T4b of T staging were respectively detected in 0,2,10,24,99,58,7 patients in the surgery group and 5,1,2,11,41,26,2patients in the chemotherapy group and 5,1,2,8,10,4,1 patients in the chemoradiotherapy group.Stage NO,N1,N2,N3a and N3b of N staging 56,41,34,47,22 patients in the surgery group and 29,17,27,10,5patients in the chemotherapy group and 18,10,2,1,0 in the chemoradiotherapy group.Cases with and without lymphovascular invasion were respectively 124,76 in the surgery group and 43,45 in the chemotherapy group and6,25 in the chemoradiotherapy group.Total number of harvested lymph nodes,number of lymph node metastases and rate of lymph node metastasis in the surgery,chemotherapy and chemoradiotherapy groups were respectively 31(range,15-87),30(range,15-62),21(range,15-36)and 3(range,0-39),2(range,0-37),0(range,0-7)and 9.2%(range,0-91.3%),7.7%(range,0-78.7%),0(range,0-30.4%).There were statistically significant differences in the T staging,N staging,with and without lymphovascular invasion,total number of harvested lymph nodes,number of lymph node melastases and rate of lymph node metastasis among groups(χ2=35.799,32.489,21.076,Z=27.120,22.088,16.947,P<0.05).There were statistically significant differences in the above indicators between surgery group and chemoradiotherapy group(χ2=28.500,20.124,19.570,P<0.05),and no statistically significant difference in the above indicators between surgery group and chemotherapy group(χ2=11.436,12.343,4.295,P>0.05).There were statistically significant differences in the N staging,with and without lymphovascular invasion,total number of harvested lymph nodes,number of lymph node metastases and rate of lymph node metastasis between chemotherapy group and chemoradiotherapy group(χ2=14.027,8.313,P<0.05),and no statistically significant difference in the T staging between chemotherapy group and chemoradiotherapy group(χ2=11.742,P>0.05).Conclusion Neoadjuvant chemoradiotherapy could reduce the total number of harvested lymph nodes and number of lymph node metastases after radical resection of proximal locally advanced GC.
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单位北京市肿瘤防治研究所; 莆田市第一医院; 恶性肿瘤发病机制及转化研究教育部重点实验室
