Risk Factors And Prognostic Impact Of No.10 Lymph Nodes Metastasis For Patients With Advanced Gastric Cancer In The Upper And/or The Middle Third Of The Stomach And Receiving Spleen-preserving Radical Resection

Objective:To explore the risk factors and prognostic impact of No.10 LNs(splenic hilar lymph nodes) metastasis in cases with the patients with advanced gastric cancer in the upper and/or the middle third of the stomach and receiving spleen-preserving radical resection.Method:The data of 243 patients with advanced gastric cancer in the upper and/or the middle third of the stomach and receiving spleen-preserving radical resection were screened from the database of our hospital from June 1st 2008 to August 31st2012.According to No.10 LNs metastasis. They were divided into positive(n=21) and negative(n=222) groups. Their clinicopathological parameters and survival outcomes were compared. The risk factors and prognostic impact of No.10 LNs metastasis were analyzed.Results:The metastatic rates of No.10 LNs were 8.6%(21/243) in all patients.It was no significance compared in two groups with genders,ages,tumor lengthwise position,preoperative serum CEA levels,Lauren types and perineural invasio. Metastasis of No.10 LNs was correlated with preoperative serum CA72-4 levels, tumor size,cross sectional location,Borrmann types,depth of tumor invasion(pT stage),the number of metastatic lymph nodes(pN stage),TNM stage,differentiation grade, vascular invasion and the cancerous nodules formed around stomach in univariate correlation analysis(P<0.05,respectively). Logistic regression analysis showed TNM stage(pT4), vascular invasion and the cancerous nodules formed around stomach was closely correlation with No.10 LNs metastasis(P<0.05,respectively). In positive and negative groups, 3-years overall survival(OS) was 12.6% VS 61.3%(x~2 =21.934,P<0.001); 2-years disease-free survival(DFS) was 15.9% VS 70.0%(x~2 =34.868,P<0.001); the positive group had poorlysurvival. Cox regression analysis showed depth of tumor invasion(pT4),TNM stage(ⅢC),the cancerous nodules formed around stomach and metastasis of No.10 LNs(HR=2.777,P=0.041,CI:1.042~7.404) were closely correlated with survival of advanced up-mid third gastric cancer patients receiving spleen-preserving radical resection.Conclusion:For patients with advanced gastric cancer in the upper and/or the middle third of the stomach and receiving spleen-preserving radical resection, TNM stage(ⅢC),vascular invasion and the cancerous nodules formed around stomach were independent risk factors of No.10 LNs metastasis. Depth of tumor invasion(pT4),TNM stage(ⅢC),vascular invasion, the cancerous nodules forming around stomach and metastasis of No.10 LNs were independent prognostic factors about poor 3-years overall survival.