Background Prophylactic para-aortic nodal dissection （PAND） has no proven benefits for potentially curable advanced gastric cancer.However,the value of therapeutic PAND for involved para-aortic nodes （PANs） in patients with locally advanced gastric cancers has not been determined yet.Methods Between 1998 and 2010,157 gastric cancer patients with 1-3 involved PANs underwent extended D2 （D2＋） lymphadenectomy plus PAND （PAND group,n=69） or extended D2 lymphadenectomy alone （non-PAND group,n=88）.The clinicopathologic features and prognostic data were compared between the two groups.A propensity score-adjusted analysis was used for a balanced comparison.Results The rate of PAN metastasis was 40.6％ （28/69） in the PAND group.The 5-year survival rate was significantly higher in the PAND group than in the non-PAND group （43.7％ vs.31.8％,P=-0.044）.Compared to the non-PAND group,the death hazard ratios in the PAND group were 0.45 （95％ CI 0.274-0.739; P=0.002） and 0.536 （95％ CI 0.328-0.861; P=-0.0097） by multivariate analysis without and with propensity score adjustment respectively.Recurrence rate at 5 years was 39.1％ in the PAND group and 43.2％ in the non-PAND group （P=0.628）.Conclusion Extended D2 lymphadenectomy plus PAND is associated with superior outcomes for advanced gastric cancer patients with 1-3 involved PANs.
目的:研究早期胃癌组织中高迁移率族蛋白1(high mobility group box1,HMGB1)表达水平与淋巴结微转移的关系。方法:采用免疫组化方法检测早期胃癌组织中HMGB1的表达水平,并采用淋巴结组织HE染色和抗细胞角蛋白抗体CK20的检测判断淋巴结微转移,探讨HMGB1表达水平与淋巴结微转移的关系。结果:62例早期胃癌患者中总共有淋巴结1334个,11例患者62个淋巴结发现CK抗体阳性细胞,总淋巴结微转移率4.64(62/1334)。HMGB1在45.1%早期胃癌组织中表达,与肿瘤浸润深度呈正相关(P<0.05),随着分化程度降低而增强,有淋巴结转移组比无淋巴结微转移组中HMGB1表达明显增强。结论:胃癌组织HMGB1表达与胃癌分化程度、侵袭、转移和淋巴结微转移密切相关,HMGB1检测对判断预后和指导治疗有重要意义。
