Background: The prognosis of stage III gastric cancer (GC) patients based on the 8th edition TNM staging system after D2 dissection was still heterogeneous. We aimed to explore clinicopathological reasons that led to the poor prognosis of these patients, especially from a surgical aspect. Methods: We divided 320 stage III GC patients who underwent distal or total gastrectomy with D2 lymphadenectomy into group 1 and group 2, according to the disease-free survival (DFS), and compared the clinicopathological features between these 2 groups. Then, we divided group 1 into group 1D and group 1T and group 2 into group 2D and group 2T, according to distal or total gastrectomy. Finally, we compared the status of lymph node (LN) metastasis in each group of perigastric LN between the subgroups, respectively. Results: Univariate analyses revealed that patients’ LN metastasis was the only significant difference between group 1 and group 2 (p #x3c; 0.05). Compared with group 1D, the percentage of patients who had metastatic LN in all groups of the perigastric LN (included No.1, 3, 4sb, 4d, 5, 6, 7, 8a, 9, 11p and 12a) increased in group 2D. A similar tendency was found in group 2T (included No.1, 2, 3, 4sa, 4sb, 4d, 5, 6, 7, 8a, 9, 10, 11p, 11d and 12a) compared with group 1T. Further multivariate regression analyses revealed that the increases of group No.12a and 5 LN were significant (p #x3c; 0.05) in group 2D, the increases of group No.12a, 8a and 6 LN were significant (p #x3c; 0.05) in group 2T, respectively. Among these, the increases of group No.12a LNs were the most significant (p #x3c; 0.01). Conclusions: The poor prognosis of patients with stage III GC after D2 dissection is mainly due to lymphatic metastasis. The status of LN metastasis in the prognostic value of GC needs to be further enhanced in present staging systems. Maybe the metastasis of No.12a LN is the most significant poor prognostic factor of these patients. It points out that the dissection of No.12a LN should be carefully performed in radical gastrectomy.
Oncol Res Treat

中文翻译：

---

D2夹层术后III期胃癌患者预后不良的主要原因是淋巴转移，尤其是No.12a LN的转移：嵌套病例对照研究

背景：基于第 8 版 TNM 分期系统的 III 期胃癌 (GC) 患者在 D2 夹层后的预后仍然存在异质性。我们旨在探索导致这些患者预后不良的临床病理原因，特别是从手术方面。方法：我们根据无病生存期（DFS）将 320 例接受远端或全胃切除术和 D2 淋巴结清扫术的 III 期 GC 患者分为第 1 组和第 2 组，并比较了这两组之间的临床病理特征。然后，我们根据远端或全胃切除术将第1组分为1D组和1T组，第2组分为2D组和2T组。最后，我们分别比较了亚组之间每组胃周 LN 的淋巴结 (LN) 转移状态。结果：单变量分析显示，患者的淋巴结转移是第 1 组和第 2 组之间唯一的显着差异（p#x3c; 0.05）。与1D组相比，2D组胃周LN各组（包括No.1、3、4sb、4d、5、6、7、8a、9、11p和12a）发生转移性LN的患者比例均增加. 与1T组相比，2T组（包括No.1、2、3、4sa、4sb、4d、5、6、7、8a、9、10、11p、11d和12a）也有类似的趋势。进一步的多元回归分析显示，2D组No.12a和5 LN的增加显着（p #x3c；0.05），No.12a、8a和6组LN的增加显着（p #x3c；0.05）分别在2T组。其中，No.12a 组 LN 的增加最为显着（p #x3c；0.01）。结论：D2 切除后的 III 期 GC 患者预后不良主要是由于淋巴转移。在目前的分期系统中，LN 转移在 GC 预后价值中的地位需要进一步加强。也许No.12a LN的转移是这些患者最显着的不良预后因素。指出在根治性胃切除术中对12a LN的清扫应慎重。
肿瘤资源治疗