The Study Of Clinical Characteristics And Prognosis Of Gastric Cancer With Metastasis Or Micrometastasis To The Lymph Node Along The Superior Mesenteric Vein

Objective:Gastric cancer is one of the most common malignant tumors of the digestive tract in the world,and the prognosis of patients with gastric cancer is extremely poor.Recurrence and metastasis of gastric cancer after operation are the most important risk factors for the prognosis of patients with gastric cancer.Lymph node metastasis is the important pathway for gastric cancer metastasis.At present,there are controversies about the indications of the dissection of the lymph node along the superior mesenteric vein(No.14v)and its treatment effect for gastric cancer.This article analyzes clinical characteristics and prognosis of gastric cancer with superior mesenteric lymph node metastasis,contributing to study the biological behavior of gastric cancer,estimate the status of lymph node metastasis,evaluate the efficacy and draw up reasonable range of lymph node dissection.Methods:Patients receiving D2 or D2~+radical gastrectomy combined with the dissection of the lymph node along the superior mesenteric vein in the department of Gastric Surgery,Liaoning Cancer Hospital from January,2003 to December,2015were retrospectively analyzed.Totally,303 patients were enrolled into the study according to inclusion and exclusion criteria.255 cases with negative No.14v lymph node were conducted the detection of micrometastases of lymph node by CK8/18immunohistochemical detection.Patients with negative micrometastatic lymph node were classified into negative group,and patients with positive micrometastatic or metastatic lymph nodes were classified into positive group.Clinical characteristics and prognosis of gastric cancer with metastasis to the lymph node along the superior mesenteric vein were studied.Results:Of the 303 patients with No.14v lymph node dissection,48 cases(15.8%)had positive No.14v lymph nodes,and 255 patients with negative No.14v lymph node received the immunohistochemical examination.Ten patients(3.3%)had positive micrometastatic lymph nodes.The total metastatic rate(positive metastatic or micrometastatic)of No.14v lymph nodes was 19.1%.Univariate analysis revealed tumor size(P=0.001),site(P=0.027),Borrmann classification(P=0.003),pT stage(P=0.001),pN stage(P=0.000),pTNM stage(P=0.000)and the number of metastatic lymph nodes(P=0.000)were associated with the metastases of No.14v lymph node.The metastasis of lymph nodes around the stomach,such as group 1,group 2,group 3,group 4,group 5,group 6,group 7,group 8,group 9,group 10,group 11,group 12,and group 13 were associated with No.14v lymph node metastasis(positive micrometastasis or metastasis).Multivariate analysis showed that tumor site(P=0.004),Borrmann classification(P=0.010),postoperative lymph node metastasis(pN)(P=0.000),the metastasis of lymph node of No.6(P=0.003)and No.9(P=0.013)were independent risk factors for positive No.14v lymph node(positive micrometastasis or metastaticsis).Survival analysis suggested gender,age,tumor size,Borrmann classification,pT stage,pN stage,pTNM stage,pathological type,degree of differentiation,the resection range,the metastatic status of No.14v lymph node was associated with patients’prognosis.And pT stage(P=0.002),pN stage(P=0.000),pathological type(P=0.043),the metastatic status of No.14v lymph node(P=0.001)and Borrmann type(P=0.001)were independent risk factors related to the prognosis.The 5-year survival rate of patients with negative micrometastatic,positive micrometastatic and positive metastatic No.14v lymph node,were 60.1%,10.0%and12.9%,respectively.The 5-year survival rate of patients of positive group(positive micrometastatic or positive metastatic)was 12.4%.The prognosis of patients with negative micrometastatic lymph node was better than that of patients with positive micrometastatic or positive metastatic lymph node,and the difference was statistically significant.While the difference between patients with positive micrometastatic and positive metastatic lymph node was not obvious.Conclusions:The metastasis of No.14v lymph node(positive micrometastatic or positive metastatic)was associated with tumor site,Borrmann classification,pT stage,pN stage,pTNM stage,and the number of metastatic lymph node.And the tumor site,Borrmann classification pN stage,the metastasis of No.6 and No.9 lymph node are most closely related the metastasis of No.14v lymph node.Borrmann type,pT stage pN stage,pathological type and the metastatic status of No.14v lymph node were the most important factors affecting patients’prognosis.The prognosis of patients with positive micrometastatic or metastatic lymph node was worse than that of patients with negative micrometastatic lymph node.The status of lymph node micrometastasis could be regarded as an indicator to evaluate the prognosis.