作者：周志豪，王志雄，黄嘉华，李广华，王昭

单位：中山大学附属第一医院 胃肠外科中心， 广东 广州 510080

Authors: Zhou Zhihao, Wang Zhixiong, Huang Jiahua, Li Guanghua, Wang Zhao

Unit: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, China

摘要：

目的 D2+淋巴结清扫术在进展期下1/3胃癌治疗中的价值。方法 选取2010年1月至2015年8月中山大学附属第一医院至少接受D2淋巴结清扫术的进展期下1/3胃癌的患者497例。利用治疗价值指数(therapeutic value index, TVI)即淋巴结站点的转移率乘以转移至该站点的5年生存率,评估清扫淋巴结站点的生存获益。结果 D2淋巴结清扫术范围内淋巴结的TVI中,No.12a淋巴结TVI最低,为2.04(转移率8.47%);No.8p淋巴结TVI为3.13(转移率9.38%)而No.12b淋巴的TVI为0.87(转移率为4.80%)、No.12p淋巴结的TVI为1.25(转移率为1.88%)、No.13淋巴结的TVI为2.04(转移率为12.24%)、No.14v淋巴结的TVI为1.79(转移率为8.93%),均低于No.12a淋巴结的TVI。结论 清扫No.8p淋巴结具有生存获益,在进展期下1/3胃癌中应纳入常规清扫范围。

关键词： 胃癌; D2+淋巴结清扫术; 治疗价值指数; 5年生存率

Abstract：

Objective The value of D2+ lymphadenectomy is controversial. The main purpose of this study was to study the value of D2 plus lymphadenectomy in the lower-third of advanced gastric cancer. Methods The patients with advanced gastric cancer who received at least D2 lymphadenectomy from January 2010 to August 2015 in the First Affiliated Hospital of Sun Yat-sen University were included. The therapeutic value index （TVI） is an internationally recognized indicator for evaluating the value of lymph node dissection, which refers to multiplying the metastasis rate of each lymph node station by the 5 -year survival rate of metastasis to the station to evaluate the survival benefit of dissecting each lymph node station. Results A total of 497 patients were enrolled, of 173 patients underwent D2 lymphadenectomy, and 324 patients underwent D2 plus lymphadenectomy. Among the TVIs of lymph nodes within the extent of D2 lymphadenectomy, the TVI of the No.12a lymph node was the lowest at 2.04 （metastasis rate was 8.47%）; The TVI of No.8p lymph node was 3.13 （metastasis rate was 9.38%）, which was higher than the TVI of No.12a lymph node, while the TVI of No.12b lymph node was 0.87 （metastasis rate was 4.80%）, the TVI of No.12p lymph node was 1.25 （metastasis rate was 1.88%）, the TVI of No.13 lymph node was 2.04 （metastasis rate was 12.24%）, and the TVI of No. 14v lymph node was 1.79 （metastasis rate was 8.93%）, which were all lower than the TVI of No.12a lymph node. Conclusion Dissection of No.8p lymph node had survival benefits and should be included in the extent of routine dissection in advanced lower-third gastric cancer.

Key Words: Gastric cancer; D2 plus lymphadenectomy; Therapeutic value index; 5-year survival