胃癌病人大网膜转移率的初步探索（Dragon 05临床预试验）

doi:10.16139/j.1007-9610.2025.01.08

摘要/Abstract

摘要： 目的： 本研究拟探究胃癌大网膜转移率。方法： 收集2020年5月于上海瑞金医院接受胃癌根治术的病人信息，分析病人的临床病理特征及大网膜转移的危险因素，分析病人的复发及生存情况。结果：本研究共纳入59例胃癌病人。2例（3.4%）存在大网膜转移。1例术后病理分期为pT4aN3bM0，另1例新辅助治疗后术后病理分期为ypT4bN1M0。纳入研究的病人3年总生存率为87.9%。结论： 胃癌大网膜转移率较低，且大网膜转移的病理分期偏晚。为进一步验证该临床问题，应开展联合大网膜切除与保留大网膜的胃癌根治术两组之间的临床前瞻性随机对照研究。

关键词: 胃癌, 大网膜, 手术

Abstract:

Objective To investigate the rate of greater omentum metastasis in gastric cancer(GC). Methods General informations of patients with GC who underwent radical gastrectomy at Shanghai Ruijin Hospital in May 2020 were collected, and their clinicopathological characteristics were analyzed to find risk factors of greater omentum metastasis. Recurrence and survival were also assessed. Results A total of 59 patients with GC were included in the study, of which 2(3.4%) had greater omentum metastasis. One patient presented a pathological stage of pT4aN3bM0 and another ypT4bN1M0. The 3-year overall survival rate of patients in the study was 87.9%. Conclusions The rate of greater omentum metastasis was relatively low, and patients with greater omentum metastasis had an more advanced pathological stage. To further validate this clinical issue, a prospective randomized controlled clinical study should be conducted between radical gastrectomy with omentectomy and omentum-preserving radical gastrectomy.

Key words: Gastric cancer, Greater omentum, Surgery

中图分类号:

R735.2

华子辰, 梅郁, 李琛, 严超, 燕敏, 朱正纲, 姚学新. 胃癌病人大网膜转移率的初步探索（Dragon 05临床预试验）[J]. 外科理论与实践, 2025, 30(01): 41-46.

HUA Zichen, MEI Yu, LI Chen, YAN Chao, YAN Min, ZHU Zhenggang, YAO Xuexin. Preliminary exploration of greater omentum metastasis rate in patients with gastric cancer: clinical pilot study of Dragon 05 trial[J]. Journal of Surgery Concepts & Practice, 2025, 30(01): 41-46.

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参考文献 36

[1]	WILKOSZ S, IRELAND G, KHWAJA N, et al. A comparative study of the structure of human and murine greater omentum[J]. Anat Embryol(Berl), 2005, 209(3):251-261.
[2]	RANGEL-MORENO J, MOYRON-QUIROZ J E, CARRAGHER D M, et al. Omental milky spots develop in the absence of lymphoid tissue-inducer cells and support B and T cell responses to peritoneal antigens[J]. Immunity, 2009, 30(5):731-743.
[3]	SEO W J, CHOI S, ROH C K, et al. Omentum preservation as an oncologically comparable and surgically superior alternative to total omentectomy during radical gastrectomy for T3-T4 gastric cancer[J]. Surgery, 2021, 170(2):610-616.
[4]	AJANI J A, D'AMICO T A, BENTREM D J, et al. Gastric cancer, version 2.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20(2):167-192.
[5]	LORDICK F, CARNEIRO F, CASCINU S, et al. Gastric cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Ann Oncol 2022, 33(10):1005-1020.
[6]	WANG F H, ZHANG X T, LI Y F, et al. The Chinese society of clinical oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer, 2021[J]. Cancer Commun (Lond), 2021, 41(8):747-795.
[7]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2021 (6th edition)[J]. Gastric Cancer,2023, 26(1):1-25.
[8]	JONGERIUS E J, BOERMA D, SELDENRIJK K A, et al. Role of omentectomy as part of radical surgery for gastric cancer[J]. Br J Surg, 2016, 103(11):1497-1503. doi: 10.1002/bjs.10149 pmid: 27550526
[9]	KIM M C, KIM K H, JUNG G J, et al. Comparative study of complete and partial omentectomy in radical subtotal gastrectomy for early gastric cancer[J]. Yonsei Med J, 2011, 52(6):961-966.
[10]	BARCHI L C, RAMOS M F K P, DIAS A R, et al. Total omentectomy in gastric cancer surgery: is it always necessary?[J]. Arq Bras Cir Dig, 2019, 32(1):e1425.
[11]	HASEGAWA S, KUNISAKI C, ONO H, et al. Omentum-preserving gastrectomy for advanced gastric cancer: a propensity-matched retrospective cohort study[J]. Gastric Cancer, 2013, 16(3):383-388. doi: 10.1007/s10120-012-0198-6 pmid: 22983455
[12]	RI M, NUNOBE S, HONDA M, et al. Gastrectomy with or without omentectomy for cT3-4 gastric cancer: a multicentre cohort study[J]. Br J Surg, 2020, 107(12):1640-1647.
[13]	KIM D J, LEE J H, KIM W. A comparison of total versus partial omentectomy for advanced gastric cancer in laparoscopic gastrectomy[J]. World J Surg Oncol, 2014,12:64.
[14]	SATO Y, YAMADA T, YOSHIKAWA T, et al. Rando-mized controlled phase Ⅲ trial to evaluate omentum preserving gastrectomy for patients with advanced gastric cancer (JCOG1711, ROAD-GC)[J]. Jpn J Clin Oncol, 2020, 50(11):1321-1324.
[15]	LU S, YANG Z Y, YAN C, et al. A randomized controlled trial to evaluate omentum-preserving gastrectomy for patients with T1-T3 gastric cancer[J]. Future Oncol, 2021, 17(25):3301-3307. doi: 10.2217/fon-2021-0240 pmid: 34008422
[16]	WHO Classification of Tumours. Digestive system tumours[R]. 5th ed. WHO, 2019.
[17]	BRIERLEY J D, GOSPODARWICZ M K, WITTEKIND C, et al. TNM classifcation of maligant tumours, 8th ed[J]. Oxford: Wiley Black well, 2017.
[18]	AMIN M B, EDGE S B, GREENE F L, et al. AJCC cancer staging manual. 8th ed[J]. New York: Springer, 2017.
[19]	HERRICK S E, MUTSAERS S E. Mesothelial progenitor cells and their potential in tissue engineering[J]. Int J Biochem Cell Biol, 2004, 36(4):621-642.
[20]	CERCI C, EROGLU E, SUTCU R, et al. Effects of omentectomy on the peritoneal fibrinolytic system[J]. Surg Today, 2008, 38(8):711-715. doi: 10.1007/s00595-007-3705-3 pmid: 18668314
[21]	MUKHERJEE A. Isolation of primary normal and cancer-associated adipocytes from the omentum[J]. Methods Mol Biol, 2022,2424:167-175.
[22]	ZHANG D, LU W, CUI S, et al. Establishment of an ova-rian cancer omentum metastasis-related prognostic model by integrated analysis of scRNA-seq and bulk RNA-seq[J]. J Ovarian Res, 2022, 15(1):123.
[23]	LIU X Y, MIAO Z F, ZHAO T T, et al. Milky spot macrophages remodeled by gastric cancer cells promote peritoneal mesothelial cell injury[J]. Biochem Biophys Res Commun, 2013, 439(3):378-383.
[24]	MIAO Z F, WANG Z N, ZHAO T T, et al. Peritoneal milky spots serve as a hypoxic niche and favor gastric cancer stem/progenitor cell peritoneal dissemination through hypoxia-inducible factor 1 alpha[J]. Stem Cells, 2014, 32(12):3062-3074.
[25]	LIU J, GENG X, LI Y. Milky spots: omental functional units and hotbeds for peritoneal cancer metastasis[J]. Tumour Biol, 2016, 37(5):5715-5726.
[26]	ZHANG C D, YAMASHITA H, SETO Y. Gastric cancer surgery: historical background and perspective in Wes-tern countries versus Japan[J]. Ann Transl Med, 2019, 7(18):493.
[27]	BLOUHOS K, BOULAS K A, HATZIGEORGIADIS A. Bursectomy in gastric cancer surgery: surgical technique and operative safety[J]. Updates Surg, 2013, 65(2):95-101. doi: 10.1007/s13304-013-0210-7 pmid: 23592040
[28]	KUROKAWA Y, DOKI Y, MIZUSAWA J, et al. Bursectomy versus omentectomy alone for resectable gastric cancer (JCOG1001): a phase 3, open-label, randomised controlled trial[J]. Lancet Gastroenterol Hepatol, 2018, 3(7):460-468.
[29]	METWALLY I H, ABDELKHALEK M, SHETIWY M, et al. Significance of omental infiltration in gastric cancer patients: a retrospective cohort study[J]. J Gastrointest Cancer, 2020, 51(3):861-867. doi: 10.1007/s12029-019-00310-0 pmid: 31677057
[30]	FUJITANI K, YANG H K, MIZUSAWA J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial[J]. Lancet Oncol, 2016, 17(3):309-318.
[31]	HAVERKAMP L, BRENKMAN H J, RUURDA J P, et al. The oncological value of omentectomy in gastrectomy for cancer[J]. J Gastrointest Surg, 2016, 20(5):885-890. doi: 10.1007/s11605-016-3092-4 pmid: 26895951
[32]	KONG M, CHEN H, ZHANG R, et al. Overall survival advantage of omentum preservation over omentectomy for advanced gastric cancer: a systematic review and meta-analysis[J]. World J Surg, 2022, 46(8):1952-1961. doi: 10.1007/s00268-022-06562-5 pmid: 35462593
[33]	LIN H W, LOH E W, SHEN S C, et al. Gastrectomy with or without omentectomy for gastric cancer: a systematic review and meta-analysis[J]. Surgery, 2022, 171(5):1281-1289.
[34]	UZUNKÖY A, OZBILGE H, HOROZ M. The influence of omentectomy on bacterial clearance: an experimental study[J]. Ulus Travma Acil Cerrahi Derg, 2009, 15(6):541-545. pmid: 20037870
[35]	MURAKAMI H, YAMADA T, TAGURI M, et al. Short-term outcomes from a randomized screening phase Ⅱ non-inferiority trial comparing omentectomy and omentum preservation for locally advanced gastric cancer: the TOP-G trial[J]. World J Surg, 2021, 45(6):1803-1811.
[36]	SAKIMURA Y, INAKI N, TSUJI T, et al. Long-term outcomes of omentum-preserving versus resecting gastrectomy for locally advanced gastric cancer with propensity score analysis[J]. Sci Rep, 2020, 10(1):16305.

Variables	Number（%）
Age（years）
Median（interquartile ranges）	63（33，86）
Gender
Male	41（69.5%）
Female	18（30.5%）
cT stage
T1-3	29（49.2%）
T4	30（50.8%）
cN stage
N0	34（57.6%）
N+	25（42.4%）
Tumor location
Cardia/fundus	5（8.5%）
Body	18（30.5%）
Pylorus/antrum	35（59.3%）
Linitis plastica	1（1.7%）
Tumor size（cm）
Median（interquartile ranges）	3（0.5，9）
Neoadjuvant therapy
Yes	8（13.6%）
No	51（86.4%）
Surgical access
Open	53（89.8%）
Laparoscopy	6（10.2%）
Type of gastrectomy
Distal	40（67.8%）
Total	19（32.2%）
Adjuvant chemotherapy
Yes	47（79.7%）
No	12（20.3%）
Histopathology type
Tubular adenocarcinoma	38（64.4%）
Signet ring cell carcinoma	5（8.5%）
Mixed adenocarcinoma	16（27.1%）
Differentiation degree
Differentiated	18（30.5%）
Undifferentiated	41（69.5%）
Greater omentum metastasis
Yes	2（3.4%）
No	57（96.6%）
Perineural invasion
Yes	28（47.5%）
No	31（52.5%）
Lymphovascular invasion
Yes	18（30.5%）
No	41（69.5%）
Pathological stage
Ⅰ	19（32.2%）
Ⅱ	15（25.4%）
Ⅲ	25（42.4%）
Tumor regression grade
0	0
1	1（12.5%）
2	7（87.5%）
3	0