Oncological risk of proximal gastrectomy for proximal advanced gastric cancer after neoadjuvant chemotherapy(vol24, 255, 2024)

被引：0

作者：

Chen, Yonghe ^{[1
,2
,3
]}

Chen, Xiaojiang ^{[4
]}

Lin, Yi ^{[1
]}

Zhang, Shenyan ^{[5
]}

Zhou, Zhiwei ^{[4
]}

Peng, Junsheng ^{[1
,2
,3
]}

机构：

[1] Sun Yat Sen Univ, Affiliated Hosp 6, Dept Gen Surg, 26 Yuancun Erheng Rd, Guangzhou 510655, Peoples R China

[2] Sun Yat Sen Univ, Affiliated Hosp 6, Guangdong Prov Key Lab Colorectal & Pelv Floor Dis, Guangzhou 510655, Peoples R China

[3] Sun Yat Sen Univ, Affiliated Hosp 6, Biomed Innovat Ctr, Guangzhou 510655, Peoples R China

[4] Sun Yat Sen Univ, Canc Ctr, Dept Gastr Surg, Guangzhou 510060, Peoples R China

[5] Sun Yat Sen Univ, Affiliated Hosp 6, Dept Pathol, Guangzhou 510655, Peoples R China

来源：

BMC CANCER | 2024年 / 24卷 / 01期

基金：

中国国家自然科学基金;

关键词：

Neoadjuvant chemotherapy; Proximal gastrectomy; Proximal gastric cancer; Tumor regression grade;

D O I：

10.1186/s12885-024-12066-3

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: This study assesses the metastasis rate of the key distal lymph nodes (KDLN) that are not routinely dissected in proximal gastrectomy, aiming to explore the oncological safety of proximal gastrectomy for upper gastric cancer who underwent neoadjuvant chemotherapy. Methods: We analyzed a cohort of 150 patients with proximal locally advanced gastric cancer (cT3/4 before chemotherapy) from two high-volume cancer centers in China who received preoperative neoadjuvant chemotherapy (NAC) and total gastrectomy with lymph node dissection. Metastasis rate of the KDLN (No.5/6/12a) and the risk factors were analyzed. Results: Key distal lymph node metastasis was detected in 10% (15/150) of patients, with a metastasis rate of 6% (9/150) in No. 5 lymph nodes, 6.7% (10/150) in No. 6 lymph nodes, and 2.7% (2/75) in No. 12a lymph nodes. The therapeutic value index of KDLN as one entity is 5.8. Tumor length showed no correlation with KDLN metastasis, while tumor regression grade (TRG) emerged as an independent risk factor (OR: 1.47; p-value: 0.04). Of those with TRG3 (no response to NAC), 80% (12/15) was found with KDLN metastasis. Conclusion: For cT3/4 proximal locally advanced gastric cancer patients, the risk of KDLN metastasis remains notably high even after NAC. Therefore, proximal gastrectomy is not recommended; instead, total gastrectomy with thorough distal lymphadenectomy is the preferred surgical approach. © The Author(s) 2024.

引用

页数：2