Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지

The Prognostic Significance of the Number of Resected Lymph Nodes in Gastric Cancer Patients

근치 절제술을 시행한 위암에서 절제림프절 수의 임상적 의의

  • Kim, Se-Jin (Department of Surgery, Korea University College of Medicine) ;
  • Jang, You-Jin (Department of Surgery, Korea University College of Medicine) ;
  • Kim, Jong-Han (Department of Surgery, Korea University College of Medicine) ;
  • Park, Sung-Soo (Department of Surgery, Korea University College of Medicine) ;
  • Park, Seong-Heum (Department of Surgery, Korea University College of Medicine) ;
  • Kim, Seung-Ju (Department of Surgery, Korea University College of Medicine) ;
  • Mok, Young-Jae (Department of Surgery, Korea University College of Medicine) ;
  • Kim, Chong-Suk (Department of Surgery, Korea University College of Medicine) ;
  • Ahn, Hyong-Gin (Department of Medical Statistics, Korea University College of Medicine)
  • 김세진 (고려대학교 의과대학 외과학교실) ;
  • 장유진 (고려대학교 의과대학 외과학교실) ;
  • 김종한 (고려대학교 의과대학 외과학교실) ;
  • 박성수 (고려대학교 의과대학 외과학교실) ;
  • 박성흠 (고려대학교 의과대학 외과학교실) ;
  • 김승주 (고려대학교 의과대학 외과학교실) ;
  • 목영재 (고려대학교 의과대학 외과학교실) ;
  • 김종석 (고려대학교 의과대학 외과학교실) ;
  • 안형진 (고려대학교 의과대학 의학통계학교실)
  • Received : 2009.06.29
  • Accepted : 2009.09.29
  • Published : 2009.12.30
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Abstract

Purpose: The objectives of this study were to investigate the impact of the number of resected lymph nodes on the survival of gastric cancer patients who underwent curative resection, and to evaluate the cut-off values that can have an influence on survival on the tumor stage-stratified analysis. Materials and Methods: The subjects were 949 gastric cancer patients who underwent curative resection at Korea University Medical Center from 1992 to 2002. They were classified according to the depth of tumor invasion, and the influence of the number of resected lymph nodes on survival was investigated. The cut-off value for the number of resected lymph nodes was determined as the smallest value that showed a significant survival difference. Results: The tumor size, location, lymph node stage, the number of metastatic lymph nodes and the number of resected lymph nodes were significantly different according to the tumor stage. The average number of resected lymph nodes was about 39, and it showed linear correlation with the number of metastatic lymph nodes. On the Cox proportional hazard model, the cut-off values of the number of resected lymph nodes, as corrected by the number of metastatic lymph nodes, was 14 for all the patients, 15 for the pT1 patients, 28 for the pT2 patients and 37 for the pT3 patients, respectively. Conclusion: Retrieving a number of lymph nodes that is more than the cut-off value could improve the survival of gastric cancer patients. Surgeons should also make efforts to perform an exact and thorough D2 lymph node dissection. Therefore, we urge surgeons to perform D2 dissection and pathologists should examine an certain exact number of lymph nodes.

목적: 위암의 근치 절제술에서 광범위 림프절 절제는 중요한 의미를 가지며 전이 림프절의 수가 종양의 침윤 정도와 함께 병기 결정의 기준이 되고 있다. 이에 저자들은 근치 절제술을 시행 받은 위암 환자에서 절제 림프절 수가 생존율에 미치는 영향을 분석하고 종양의 각 병기에 따라서 생존율 및 병기결정에 영향을 미치는 절제 림프절수의 최소 기준값을 구하고자 하였다. 대상 및 방법: 1992년부터 2002년까지 고려대학교병원에서 근치적 위절제술을 시행 받고 5년 이상 추적 관찰이 가능하였던 949명의 환자들을 대상으로 하였다. 조직검사결과에 따른 종양 침윤 정도에 따라 환자군을 분류하여 절제 림프절의 수를 조사하였다. 절제 림프절 수의 최소 기준값은 생존율에 유의한 차이를 보이는 최소값으로 정하였다. 결과: 종양의 크기, 위치, 림프절 병기, 전이 림프절의 수 및 절제 림프절의 수는 종양의 병기에 따라 유의한 차이를 보였다. Cox 비례위험모형을 통한 분석 결과 절제 림프절 수의 최소 기준값은 전체 환자에서는 14개였으며 각 병기별로 pT1군에서 15개, pT2군에서 28개, pT3군에서 37개의 값을 보였고 기준값 이상으로 절제된 경우 생존율이 유의하게 높았다. 결론: 근치적 위절제술을 받은 환자에서 기준값 이상의 림프절 절제가 생존을 향상시킬 수 있으며 이를 위해 외과의가 근치적 위절제술 시 기준값 이상의 림프절 절제술을 위해 노력해야 하며 병리의는 절제된 조직의 림프절 개수의 정확한 결과를 보고 하기 위해 더욱 노력해야 할 것이다.

Keywords

References

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