The Research Of Clinicopathological Parameters And Clinical Significance Of No.12b Lymph Node Metastasis In Gastric Antrum Cancer

Objective:To investigate the clinicopathological factors associated with lymph node metastasis in No.12 b lymph node of gastric antrum cancer and the clinical significance of lymph node dissection.Methods: Antibody CK8/18 was used to detect lymph node micrometastasis in No.12 b lymph node by immunohistochemical Envision two-step method.The number of lymph node positive cases in 242 patients was determined.The clinicopathological features of lymph node metastasis(micrometastasis)in No.12 b lymph node were determined by chi-square test and logistic multiple regression.COX regression model was used to analyze the prognostic independent factors of the 242 cases and the positive group of No.12 b lymph nodes.Survival data was analyzed by Kaplan-Meier survival method.Results:Micrometastasis detection showed that 7 lymph nodes were positive.The positive rate of No.12 b lymph nodes was 9.1%.Logistic regression analysis showed that lymph node metastasis in No.12 b was positively correlated with serosal classification(P=0.004),N stage(P=0.044),No.1(P=0.011),No.8a(P=0.028),No.12a(P=0.008).Univariate and multivariate analysis clarified that No.12 b was an independent prognostic factor(P=0.008).Further subgroup analysis showed that the prognosis of patients with No.12 b lymph node metastasis was significantly correlated to the differentiation of primary tumors(P=0.043),serosa typing(P=0.008),T stage(P=0.036),N stage(P=0.003),TNM stage(P=0.017)and No.12a(P=0.028).Survival analysis also demonstrated that the 5-year recurrence free survival(RFS)of patients with No.12b(+)group were worse than those without metastasis(P<0.001 and 0.015),and shorter that of No.12b(-)group in stage I/II/III(P=0.000).However,the 5-year RFS of No.12b(+)dissection group were better than without dissection group in the same period(N2-3 stage)(P=0.046).Conclusion:Micrometastasis detection can improve the positive rate of lymph nodes.For patients with distal gastric cancer,the survival of patients with lymph nodemetastasis in No.12 b lymph node was better than that of patients with metastasis.The serosal typing,N stage,No.1,No.8a and No.12 a lymph node metastasis are closely related to No.12 b lymph node metastasis.During preoperative examination or intraoperative exploration,the patients with gastric antrum cancer who are suspected of having lymph node metastasis in No.8a or No.12 a,or with high N stage(N stage?2),routine lymph node dissection in No.12 b is recommended.