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目的研究国际抗癌联盟(UICC)和美国癌症联合会(AJCC)对胃癌TNM分期系统中准确分期的最少检出淋巴结数目。方法回顾性收集436例行胃癌根治术的患者淋巴结数目、生存率等临床和病理资料,通过卡方检验和q检验方法对其进行分析。结果在pN0病例中,送检淋巴结1～4个,5～9个的病例,比10～14个和15个以上的5年生存率低且差异具有统计学意义(P<0.05)。10～14个检出淋巴结的病例与15个以上的5年生存率差别无统计学意义。在pN1,pN2患者,送检1～4个,5～9个和10～14个淋巴结者与15个以上者的生存率差别具有统计学意义(P<0.05)。Ⅱ期中检出10～19个淋巴结的患者,其5年生存率明显低于20～29个及30个以上的患者,在Ⅲ期中,检出5～9,10～19,20～29个淋巴结者生存率显著低于30个以上的生存率(P<0.05)。结论淋巴结检出数目在胃癌pN分期中显著影响预后。pN0的最少检出数目应由原来的15个减至10个。而有淋巴结转移的病例至少应送检15个以上淋巴结。Ⅱ期病例最好检出20个淋巴结,而Ⅲ、Ⅳ期最好检出30个以上淋巴结。
Objective To study the minimum number of lymph nodes detected by UICC and AJCC in accurately staging gastric cancer TNM staging system. Methods Retrospectively collected clinical and pathological data of 436 patients with radical gastrectomy, such as the number of lymph nodes and survival rate, and analyzed by chi-square test and q-test. Results In pN0 cases, there were 1 to 4 lymph nodes and 5 to 9 cases with lower 5-year survival rates than those of 10-14 and 15 (P <0.05). There was no significant difference between 10 ~ 14 cases of detected lymph nodes and 15 years of 5-year survival rate. In pN1 and pN2 patients, there was a significant difference in the survival rates between 1 ~ 4, 5 ~ 9, and 10 ~ 14 lymph nodes and more than 15 patients (P <0.05). Patients with 10-19 lymph nodes detected in stage II had a significantly lower 5-year survival rate than those with 20-29 and more than 30 patients. In stage III, 5-9, 10-19, and 20-29 lymph nodes were detected The survival rate was significantly lower than 30 more than the survival rate (P <0.05). Conclusion The number of lymph nodes detected in pN staging of gastric cancer significantly affects the prognosis. The minimum number of pN0 detections should be reduced from 15 to 10. Cases with lymph node metastases should be sent to at least 15 lymph nodes. Ⅱ stage cases detected the best 20 lymph nodes, and Ⅲ, Ⅳ best detected more than 30 lymph nodes.