Primary Study on Metastatic Rate and Metastasis of Subpyloric Lymph Nodes in Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Jie , YANG Kun , CHEN Xinzu , ZHANG Bo , CHEN Zhixin , CHEN Jiaping , HU Jiankun.

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Gastric cancer; Dissection of lymph node; No.6 group lymph nodes; lymph node metastasis

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ObjectiveTo explore the value on excision of subpyloric (No.6 group) lymph nodes of stomach by detection of metastatic rate and metastasis of lymph nodes of No.6 group and its subgroups. MethodsThe clinical data including complete information on No.6 group and its subgroups lymph nodes in 80 patients underwent gastrectomy and subpyloric lymph nodes dissection for gastric cancer from January 2006 to December 2009 were retrospectively analyzed. Referring to the right gastroepiploic vein, the No.6 lymph nodes were divided into three subgroups (No.6a, No.6b, and No.6c subgroup), and the relationship between the metastasis of No.6 lymph nodes and clinicopathologic features as well as the metastasis of No.7, No.8a， and No.9 lymph nodes were analyzed by logistic regression analysis. ResultsThe metastatic rate of No.6 group lymph nodes was 41.3% (33/80) and with 26.0% (108/415) of the resected lymph nodes involved. The metastatic rate of lymph nodes in No.6a subgroup (7.5%, 6/80) was significantly lower than that in No.6b (16.3%, 13/80) and No.6c subgroup (36.3%, 29/80), P lt;0.001. The metastasis of the resected lymph nodes in No.6a, No.6b, and No.6c subgroup was 25.0% (8/32), 17.6% (13/74), and 28.2% (87/309), respectively, and the difference was not significant (P=0.292). The metastasis of lymph nodes in No.6a subgroup was correlated to T stage (P=0.042) and N stage (P=0.006). The metastasis of lymph nodes in No.6b subgroup was correlated to N stage (P=0.002) and TNM stage (P=0.013). The metastasis of lymph nodes in No.6c subgroup was correlated to differentiation degree of tumor (P=0.008), T stage (P=0.003), N stage (P=0.000), and TNM stage (P=0.000). The logistic regression analysis showed that the metastasis of lymph nodes was correlated to the metastasis of No.8a lymph nodes (P=0.023) and N stage (P=0.002) in No.6 group, the metastasis of No.8a lymph nodes (P=0.018) in No.6a subgroup, N stage (P=0.005) in No.6b subgroup, and the metastasis of No.8a lymph nodes (P=0.016) and N stage (P=0.004) in No.6c subgroup. ConclusionAttentions should be paid to the complete dissection of subpyloric lymph nodes in gastric cancer surgery, especially for the lymph nodes of No.6a and No.6b subgroups.

Citation： LIU Jie,YANG Kun,CHEN Xinzu,ZHANG Bo,CHEN Zhixin,CHEN Jiaping,HU Jiankun.. Primary Study on Metastatic Rate and Metastasis of Subpyloric Lymph Nodes in Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 295-299. doi: Copy

1.	Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world [J]. J Clin Oncol, 2006, 24(14): 21372150.
2.	Hu JK, Yang K, Zhang B, et al. D2 plus paraaortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery [J]. Surg Today, 2009, 39(3): 207213.
3.	Yonemura Y, Wu CC, Fukushima N, et al. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer [J]. Int J Clin Oncol, 2008, 13(2): 132137.
4.	Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009, 197(2): 246251.
5.	Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008, 359(5): 453462.
6.	陈峻青. 胃癌外科治疗几个问题的新进展 [J]. 中国普外基础与临床杂志, 2010, 17(1): 14.
7.	所剑. 胃癌的淋巴结清扫及意义 [J]. 中国普外基础与临床杂志, 2010, 17(1): 57.
8.	Chen XZ, Hu JK, Zhou ZG, et al. Metaanalysis of effectiveness and　safety of D2 plus paraaortic lymphadenectomy for resectable gastric cancer [J]. J Am Coll Surg, 2010, 210(1): 100105.
9.	胡建昆, 陈佳平, 陈志新, 等. 胃癌外科切除治疗(附428例报告) [J]. 四川大学学报(医学版), 2003, 34(4): 771773.
10.	Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004, 90(10): 18881892.
11.	日本胃癌學會. 胃癌治療ガイドライン医師用 [M]. 第3版. 東京: 金原出版社, 2010： 610.
12.	日本胃癌學會. 胃癌取扱い規約 [M]. 第14 版. 東京: 金原出版, 2010: 218.
13.	Nunobe S, Hiki N, Ohyama S, et al. Outcome of surgical treatment for patients with locoregional recurrence of gastric cancer [J]. Langenbecks Arch Surg, 2010. DOI: 10.1007/s0042301007302.
14.	Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1 853 patients [J]. Ann Surg, 2007, 245(4): 543552.
15.	Coimbra FJ, Costa WL Jr, Montagnini AL, et al. The interaction between Ncategory and Nratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil [J]. Eur J Surg Oncol, 2011, 37(1): 4754.
16.	Saito H, Fukumoto Y, Osaki T, et al. Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer [J]. J Surg Oncol, 2008, 97(2): 132135.
17.	Yokota T, Ishiyama S, Saito T, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis [J]. Scand J Gastroenterol, 2004, 39(4): 380384.
18.	Shiraishi N, Sato K, Yasuda K, et al. Multivariate prognostic study on large gastric cancer [J]. J Surg Oncol, 2007, 96(1): 1418.
19.	胡建昆, 陈志新, 张波, 等. 胃癌根治术中No.8淋巴结清扫的意义和技巧 [J]. 中国普外基础与临床杂志, 2007, 14(5): 560563.
20.	Choi WH , Kim S, Shen J, et al. Prognostic significance of perinodal extension in gastric cancer [J]. J Surg Oncol, 2007, 95(7): 540545.
21.	毛伟征, 陈峻青, 王舒宝, 等. 胃下部癌淋巴结转移规律及其临床意义 [J]. 中华胃肠外外科杂志, 2002, 5(1): 2427.
22.	李国立, 刘福坤, 曹建民, 等. 血管造影对胃癌浸润深度的诊断及对淋巴结转移规的观察 [J]. 中华外科杂志, 2001, 39(3): 232234.

1. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world [J]. J Clin Oncol, 2006, 24(14): 21372150.
2. Hu JK, Yang K, Zhang B, et al. D2 plus paraaortic lymphadenectomy versus standardized D2 lymphadenectomy in gastric cancer surgery [J]. Surg Today, 2009, 39(3): 207213.
3. Yonemura Y, Wu CC, Fukushima N, et al. Randomized clinical trial of D2 and extended paraaortic lymphadenectomy in patients with gastric cancer [J]. Int J Clin Oncol, 2008, 13(2): 132137.
4. Yang SH, Zhang YC, Yang KH, et al. An evidencebased medicine review of lymphadenectomy extent for gastric cancer [J]. Am J Surg, 2009, 197(2): 246251.
5. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with paraaortic nodal dissection for gastric cancer [J]. N Engl J Med, 2008, 359(5): 453462.
6. 陈峻青. 胃癌外科治疗几个问题的新进展 [J]. 中国普外基础与临床杂志, 2010, 17(1): 14.
7. 所剑. 胃癌的淋巴结清扫及意义 [J]. 中国普外基础与临床杂志, 2010, 17(1): 57.
8. Chen XZ, Hu JK, Zhou ZG, et al. Metaanalysis of effectiveness and　safety of D2 plus paraaortic lymphadenectomy for resectable gastric cancer [J]. J Am Coll Surg, 2010, 210(1): 100105.
9. 胡建昆, 陈佳平, 陈志新, 等. 胃癌外科切除治疗(附428例报告) [J]. 四川大学学报(医学版), 2003, 34(4): 771773.
10. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004, 90(10): 18881892.
11. 日本胃癌學會. 胃癌治療ガイドライン医師用 [M]. 第3版. 東京: 金原出版社, 2010： 610.
12. 日本胃癌學會. 胃癌取扱い規約 [M]. 第14 版. 東京: 金原出版, 2010: 218.
13. Nunobe S, Hiki N, Ohyama S, et al. Outcome of surgical treatment for patients with locoregional recurrence of gastric cancer [J]. Langenbecks Arch Surg, 2010. DOI: 10.1007/s0042301007302.
14. Marchet A, Mocellin S, Ambrosi A, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1 853 patients [J]. Ann Surg, 2007, 245(4): 543552.
15. Coimbra FJ, Costa WL Jr, Montagnini AL, et al. The interaction between Ncategory and Nratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil [J]. Eur J Surg Oncol, 2011, 37(1): 4754.
16. Saito H, Fukumoto Y, Osaki T, et al. Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer [J]. J Surg Oncol, 2008, 97(2): 132135.
17. Yokota T, Ishiyama S, Saito T, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis [J]. Scand J Gastroenterol, 2004, 39(4): 380384.
18. Shiraishi N, Sato K, Yasuda K, et al. Multivariate prognostic study on large gastric cancer [J]. J Surg Oncol, 2007, 96(1): 1418.
19. 胡建昆, 陈志新, 张波, 等. 胃癌根治术中No.8淋巴结清扫的意义和技巧 [J]. 中国普外基础与临床杂志, 2007, 14(5): 560563.
20. Choi WH , Kim S, Shen J, et al. Prognostic significance of perinodal extension in gastric cancer [J]. J Surg Oncol, 2007, 95(7): 540545.
21. 毛伟征, 陈峻青, 王舒宝, 等. 胃下部癌淋巴结转移规律及其临床意义 [J]. 中华胃肠外外科杂志, 2002, 5(1): 2427.
22. 李国立, 刘福坤, 曹建民, 等. 血管造影对胃癌浸润深度的诊断及对淋巴结转移规的观察 [J]. 中华外科杂志, 2001, 39(3): 232234.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Primary Study on Metastatic Rate and Metastasis of Subpyloric Lymph Nodes in Gastric Cancer

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