医脉通编译，转载请务必注明出处
2016年6月3-7日，一年一度的美国临床肿瘤学会（American Society of Clinical Oncology，ASCO）年会将在芝加哥举办。6月4日上午的消化系统（非结直肠）肿瘤壁报专场上，福建医科大学附属协和医院的黄昌明教授呈现了一项摘要号为4051的中国研究，该项研究对来自中国两家机构的2947例胃癌患者数据进行分析，为胃切除术后患者应该移除多少数量的淋巴结给出了答案，医脉通整理如下：
尽管目前的指南建议，对胃癌进行适当分期需要16个或更多的淋巴结（LNs），而在不同胃切除方式中最少被检出淋巴结（eLNs）数量对生存的影响仍不清楚。
来自中国的研究人员对2662例因胃癌接受D2淋巴结清扫根治性切除术的患者进行回顾性分析，这些患者于2000年1月到2010年12月在福建医科大学协和医院接受治疗，并随机将他们分为进展（70%，n=1863）和验证（30%，n=799）数据集。一项附加的额外验证在同一时期从广州中山大学癌症中心收集数据（n=285）来开展。同时研究人员以eLNs和预后为基础，提出一种假设的TNM分类（hTNM）。
在根除性远端胃切除术和全胃切除术期间，移除结节的平均数量分别为26±9.6和29±10.7（P＜0.01）。对于分别接受根除性远端胃切除术和全胃切除术的患者来说，最佳LNs计数临界值确定为16和21。相比于第7版AJCC TNM分期，hTNM分期系统具有较高的线性趋势和似然比Χ2分数以及较低的AIC值；因此，这种hTNM分期系统会呈现出优异的预后分层。类似的结果在两个验证数据集中被发现。
综上，胃癌根治性全胃切除术（RTG）后，为了最大化生存获益，21个最少被检出淋巴结数目应该被移除。对于接受RTG患者来说，hTNM分期系统预测生存期可能更准确并有区别性，这种提议的系统会在临床有很好的应用。
会议专题》》》2016年ASCO年会专题报道
原文摘要：
How many lymph nodes should be removed to define an optimal D2 lymphadenectomy for gastric cancer in the modern era? An analysis of 2,947 patients from a two-institution database in China.(Abstract 4051)
Authors：Changming Huang, Jun Lu,et al
Session Type：Poster Session
Background: Although current guidelines suggest that 16 or more lymph nodes (LNs) are required for the appropriate staging of gastric cancer, the effect on survival of the minimum number of examined LNs (eLNs) in the different types of gastrectomy remains unclear.
Methods: We retrospectively analyzed 2662 patients who underwent curative gastrectomy with D2 lymphadenectomy for gastric cancer at Fujian Medical University union Hospital from Jan 2000 to Dec 2010 and randomly divided them into development (70%, n＝1863) and validation (30%, n＝799) datasets. An additional external validation was performed using the data set (n＝285) that was collected during the same period from the Sun Yat-sen University Cancer Center in Guangzhou, China. A hypothetical TNM classification (hTNM) was proposed based on eLNs and prognosis.
Results: The mean numbers of nodes removed during radical distal and total gastrectomy were 26±9.6 and 29±10.7, respectively (p＜0.01). The optimal LNs count thresholds were determined to be 16 and 21 for patients who underwent curative distal and total gastrectomy, respectively. The hTNM staging system had higher linear trend and likelihood ratioΧ2 scores and lower AIC values than the seventh AJCC TNM classification; thus, the hTNM staging system exhibited superior prognostic stratification. Similar results were found in the two validation datasets.
Conclusions: To maximize the survival benefit after radical total gastrectomy (RTG) for gastric cancer, a minimum of 21 LNs should be removed. For patients undergoing RTG, the hTNM staging system may predict survival more accurately and discriminatively, and this proposed system could have good clinical utility.
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