【摘要】 [目的]研究淋巴结转移率(MLR)与Ⅲ期胃癌患者D2根治术后生存率和化疗获益的关系。[方法]选取2010年1月～2013年12月我院收治的87例Ⅲ期胃癌患者作为研究对象,进行回顾性研究。患者行胃癌R0切除伴D2淋巴结清扫术,其中83例接受胃全切除,4例接受胃大部切除术;57例患者接受含5-Fu的辅助化疗。通过Kaplan-Meier法分析患者生存率。[结果]淋巴结总数的中位值是35(10～104),转移淋巴结的中位数是8(0～71)。中位生存期31.7个月,3年生存率36.4%。患者按MLR分为4组:MLR0,0;MLR1,<0.1;MLR2,0.1～0.25;MLR3,>0.25。中位随访31个月后,MLR0到MLR3组患者中位生存时间分别是37.1个月、35.9个月、31.5个月、20.8个月(P=0.013)。选取中位值0.24作为MLR高低的临界值,MLR<0.24的患者中,采用辅助化疗和不采用辅助化疗的中位生存期分别是39.3个月和36.5个月。MLR>0.24的患者中,采用辅助化疗和不采用辅助化疗的中位生存期分别是22.9个月和12.2个月(P=0.002)。多变量分析表明,MLR是一个独立的预后因素。[结论]Ⅲ期胃癌患者行R0切除伴D2淋巴结清扫术后,MLR是一个有效的预后指标;高MLR患者可能从辅助化疗中获益最多。更多还原

【Abstract】 [Objective] To investigate the prognostic value of metastatic lymph node ratio(MLR) and adjuvant chemotherapy in Ⅲ gastric cancer after D2 nodal dissection. [Methods]A total of 87 gastric cancer patients from January 2010 to December 2013 were retrospectivelyenrolled in this study.Of these patients, 83 underwent total gastrectomy, the remaining 4 underwent subtotal gastrectomy and 57 patients received adjuvant chemotherapy with fluoropyrimidines.Survival analysis was determined by the Kaplan-Meier method. [Results]Median total retrieved lymph node number was 35(range: 10-104) with median metastatic lymph node amount of eight(range: 0-71). Median survival time was 31.7 months with a 3-year survival rate of 36.4%. Patients were divided into four groups according to MLR: MLR0, 0; MLR1, <0.1; MLR2, 0.1-0.25; MLR3, >0.25. After median follow-up of 31 months, median OS rates of MLR0 to MLR3 were 37.1 m, 35.9 m, 31.5 m and 20.8 m, respectively(P=0.013). Median survival time were 9.3 m and 36.5 m in low subgroups(MLR<0.24) with or without adjuvant chemotherapy; 22.9 m and 12.2 m were found in high subgroups(MLR>0.24) with and without chemotherapy, respectively(P=0.002). Finally, MLR constituted an independent prognostic factor in multivariable analysis. [Conclusion]After R0 resection with D2 lymphadenectomy for stage Ⅲ gastric cancer, MLR constitutes an effective prognostic indicator. Patients with high MLR may benefit from adjuvant chemotherapy.更多还原