Lymph Node Metastasis of Gastric Cancer

胃癌的淋巴腺轉移

蔡孟叡(Meng-Jui Tsai) ； 羅永男(Yung-Nan Luo) ； 李孟達(Meng-Dar Lee) ； 劉茂和(Mao-Ho Liu) ； 王鐘貴(Chung-Kwe Wang)

《北市醫學雜誌》 3卷6期 (2006/06) Pp. 620-631

https://doi.org/10.6200/TCMJ.2006.3.6.10

摘要

目的：局部侵犯和淋巴腺轉移為胃癌病患接受手術後預後之最重要之因素。但是由於國際上對於淋巴腺之分期存在明顯之差異，對於治療結果之比較有相當大的困難。本研究之目的在於提出不同期別不同解剖位置淋巴腺轉移之機率，以作為淋巴腺清除之理論基礎。方法：1974年至2004年之間1264位胃癌病患在本院外科接受胃切除手術。880位接受第二群淋巴腺清除之治癒性切除，每一不同編號之清除病例數及轉移病例數予以計算,以分析淋巴腺轉移之機率。結果：手術方式包括998例之次全胃切除，176例之全胃切除，84例之近端胃切除，254例為早期癌。根據日本分類之第一群淋巴腺轉移率為18%，第二群淋巴腺轉移率為25.2%，第三群淋巴腺轉移率為12.2%。無淋巴腺轉移之病患五年生存率為83.6%。根據國際TNM淋巴腺分類第一、二、三群淋巴腺轉移病例五年生存率分別為56.7%、29.8%和20.7%。根據日本淋巴腺分類第一、二、三群淋巴腺轉移病例五年生存率分別為61.9%，34.7%和23.1%。結論：根據本研究淋巴腺轉移之機率，對於進行癌必須施以D2淋巴腺清除，國際TNM淋巴腺分類雖然在西方國家較容易施行，但是分期之準確度尚須要更多的研究和分析。

關鍵字

胃癌 ； 淋巴腺

並列摘要

Background and Purpose: The local invasion and lymphatic involvement are the most important prognostic factors for patients with gastric carcinoma undergoing curative resection. Because of the differences among the present classification systems defined by the international Union Against Cancer (UICC), American Joint Committee on Cancer (AJCC) and Japanese Gastric Cancer Association (JGCA), international comparison of treatment result is difficult. The aim of this study is to provide an anatomic analysis of lymph node status as a theoretical basis of extended lymph node dissection which is now considered the choice of procedure for gastric cancer. Methods: Between 1974 and 2004, 1264 patients of gastric cancer underwent gastrectomy at the surgical department of Zen-Ai hospital. 880 of them (88.2%) had a D2 or greater lymphadenectomy. For these 880 patients, the number of dissected cases and number of metastasized cases in each station were calculated to analyze the incidence of metastasis. Results: The surgical procedure included 998 distal gastrectomies (79%), 176 total gastrectomies (13.9%) and 84 proximal gastrectomies (6.6%) for limited proximal lesions. There were 254 cases of early gastric cancer (20.1%). According to the Japanese N staging, pN1 represented 18% (228 cases), pN2 25.2% and pN3 12.2% of the cases. The 5-year survival rate for node-negative patients was 83.6%. The 5-year survival rates of the patients staged by the AJCC/UICC pN classification were 56.7% for pN1, 29.8% for pN2 and 20.7% for pN3. When classified by the Japanese system, the 5-year survival rates of the patients were 61.9% for pN1, 34.7% for pN2 and 23.1% for pN3. Conclusion: Dissection of the tier two lymph node is theoretically beneficial for gastric cancer based on the incidence of lymph metastasis shown in this study. Although the AJCC TNM system is more easily applied in the Western country and more reproducible because of its simplicity, the accuracy of stage needs further comparison and study.

並列關鍵字

Gastric cancer ； lymph node metastasis ； international Union Against Cancer UICC ； American Joint Committee on Cancer AJCC ； Japanese Gastric Cancer Association JGCA