| Objective: Invasion and metastasis are the main reason for the death of patients with cardiac cancer and lymph node metastasis is the most significant characteristic in them .This study was designed to investigate the relation between lymph node metastasis and prognosis in cardiac cancer statistically.Methods : A total of 105 patients with cardiac cancer who underwent surgical resection from 1986 to 1987 were retrospectively reviewed. Of these patients ,90 were male and 15 were female (6:1).The average age was 54.8(ranged from 30-78 years old). TNM Classification: 14 were in Stage II, 91 in Stage III.Type of lymph node dissection : DO was performed in 5 patients , D1 in 11 patients ,D2 in 82 patients and D3 in 7 patients. Total gastrectomy was performed in 8 patients , subtotal gastrectomy in 97 patients ,among these combined pancreatic tail and spleen resection was performed in 11 patients. Lymph node metastasis was present in 91 patients (86.67%). A total of 2356 lymph nodes was dissected , 700 were positive (29.60%),an average of 22.52 lymph nodes was dissected.Results: At the time of the last follow-up, 12 patients were lost in this group,lost cases and operative mortality cases were treated as censored data for the analysis of survival rates, the average follow-up interval was 56.59 months, the mean survival time was 39.00 months. Thel-,3-,5-and 10-year overall survival rates of patients were 87.62%,50.48%,27.62 and 8.57%. Thel-,3-,5-and 10-year overall survival rates of patients with lymph node metastasis were 86.81%,45.05%,20.88% and 6.59%. Thel-,3-,5-and 10-year overall survival rates of patients without lymph node metastasis were 92.86%,85.71%,71.43% and 21.43%.All statistical analyses were performed using SPSS10.0.The results indicated Groupl,2,3,5,8,10,ll lymph node metastasis correlated with prognosis signif!cantly,Groupll was the most important ,the otherswere Group5 and 8.Lymph node metastasis and the rate of lymph node metastasis were significantly correlated with prognosis in cardiac cancer.Conclusions: The lymph node status is closely correlated with prognosis in patients with cardiac cancer , therefore lymph node dissection especially in peritoneum may improve the prognosis. Discussion: Tumor size ,depth of tumor invasion, microscopic type , lymph node status and therapeutics have been previously described as prognostic factors in cardiac cancer . This study indicates that lymph node metastasis is the most important factor that affects the prognosis of cardiac cancer, especially Group 11 ,the others are Group 5 and 8.When Group 11 is positive , this indicates the possibility spread of cancer to the thoracic duct or abdominal aorta ,Group5 positive indicates the metastasis to retropancreatic area and mesenteric root and Group8 is the sign of hepatic artery and hepatoduodenal ligament metastasis .Group10 indicates the splenic hilas or splenic artery or pancreatic tail spread. Group 1,2,3 lymph nodes are defined as N1 , they are more easily be invaded ,when they are found to be positive ,it indicates the occurrence of lymph node metastasis .The direction of lymph node metastasis is along the lesser curvatures of stomach to left gastric vessels ,Group7 is the very site of lymph node metastasis to N2 and N3,in highly malignant tumor Group7 positive is prevalent .Since peritoneal metastasis is the important direction of lymph node invasion in cardiac cancer ,careful peritoneal lymph node dissection is necessary , in most patient D2 procedure is adequate which should include Groupll ,Group 5 and 8 besides Group7. As for thoracic extent, radical lymph node dissection should be performed below the inferior pulmonary vein which includes Group110 and Group 111 lymph nodes. |
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