AB20. Clinicopathological features relating to lymph nodes metastasis and impact of the extent of lymphadenectomy on prognosis in early gastric cancer
Hui Wu, Liang Wang, Yu-Long He, Jian-Bo Xu, Shi-Rong Cai, Jin-Ping Ma, Chuang-Qi Chen, Xin-Hua Zhang, Wen-Hua Zhan
Objective: To explore relative factors of lymph nodes (LN) metastasis and impact of the extent of lymphadenectomy on prognosis in early gastric cancer (EGC).
Methods: A total of 142 cases with EGC were screened from data base of Gastric cancer of Sun Yat-sen University, from August 1994 to January 2010. According to LN metastasis, they were divided into negative (n=116) and positive (n=26) group. The clinicopathologic features between the two groups and impact of extent of lymphadenedtomy on prognosis were analyzed.
Results: There were no significant differences in Age, gender, tumor size and location, Borrmann type, WHO type, histological type andCEA value between two groups (P>0.05). In negative and positive group, the ratio of TNM stage IA, IB, II were 100% vs. 0.0%, 0.0% vs. 88.5%, 0.0% vs. 11.5% respectively, with significant difference (P0.05). Median number of LN dissected in D1 and D2 cases was 4 (0,16) and 20 (12,30) respectively, with significant difference (P=0.000). But the number of positive LN is without significant difference (P=0.502). The postoperative complication rate was 11.1% vs. 3.3% in D1 and D2 dissection respectively, without significant difference (P=0.128). COX regression analysis showed the extent of lymphadectomy, LN metastasis were the independent prognostic factors for EGC. The median survival time in negative and positive group was 156 vs. 96 months (P=0.010). In cases received D2 and D1 dissection, median survival time (MST) was 96 vs. 156 months (P=0.0022). In negative group, MST in cases received D1 and D2 dissection was 156 vs. 96 months, but had no significant difference (P=0.502). In positive group, D2 dissection prolonged survival time significantly than D1 dissection (27 vs. 96 months) (P=0.001).
Conclusions: It could not assess the status of LN metastasis accurately preoperatively according to the ordinary clinicopathological features. For the cases with unclear LN metastasis, D2 dissection should be the first choice, compared with D1 dissection, the motality and complication rate didn’t increase, but survival time prolonged.
Keywords: Stomach neoplasms; early diagnosis; neoplasms metastasis; lymph node excision; prognosis
