在晚期近端胃癌的全胃切除手术中，不再推荐进行脾门（10号）淋巴结清扫。然而，对于Borrmann 4型肿瘤的10号淋巴结清扫的治疗效果尚不清楚。我们在韩国的四家重要机构中招募了2006年至2016年间接受Borrmann 4型肿瘤全胃切除手术的539名患者。我们使用倾向得分（治疗概率的倒数）比较了进行10号淋巴结清扫组（n=309）和无清扫组（n=230）的长期生存情况。使用Cox比例风险回归模型和鲁宾型鲁宾方差估计器，评估了经过倾向得分加权样本中的10号淋巴结清扫的治疗效果。经过治疗概率倒数加权后，10号淋巴结清扫组有540.4名患者，无清扫组有532.7名患者。两组基线特征，包括肿瘤淋巴结转移分期，表现出良好的平衡。无淋巴结清扫组和10号淋巴结清扫组的5年生存率分别为45.7%和38.6%（对数秩和检验p=0.036，危险比0.786，95%置信区间0.630-0.982）。多变量分析显示，10号淋巴结清扫是一个独立的有利的预后因素（校正危险比0.747，95%置信区间0.593-0.940），在其他预后因素的调整后仍然存在。对其他倾向得分加权模型和倾向得分匹配模型进行的敏感性分析显示了类似的结果。相比无清扫组，接受10号淋巴结清扫患者的生存情况得到了改善。对于Borrmann 4型胃癌患者，在全胃切除手术中推荐进行10号淋巴结清扫。©2023. Springer Nature Limited.

Splenic hilar (no.10) lymph node dissection during total gastrectomy is no longer recommended for advanced proximal gastric cancer. However, the treatment efficacy of no.10 lymph node dissection in Borrmann type 4 tumors remains unclear. We enrolled 539 patients who underwent total gastrectomy for Borrmann type 4 tumors between 2006 and 2016 in four major institutions in Korea. We compared the long-term survival of the no.10 lymph node dissection (n = 309) and no-dissection groups (n = 230) using the propensity score (inverse probability of treatment weighting). The treatment effects of no.10 lymph node dissection were estimated in the weighted sample using the Cox proportional hazards regression model with a robust sandwich-type variance estimator. After inverse probability of treatment weighting, there were 540.4 patients in the no.10 lymph node dissection group and 532.7 in the no-dissection group. The two groups showed well-balanced baseline characteristics, including tumor node metastasis stage. The 5-year survival rates in the no.10 lymph node dissection and no-dissection groups were 45.7% and 38.6%, respectively (log-rank p = 0.036, hazard ratio 0.786, 95% confidence interval 0.630-0.982). Multivariate analysis revealed that no.10 lymph node dissection was an independent favorable prognostic factor (adjusted hazard ratio 0.747, 95% confidence interval 0.593-0.940) after adjusting for other prognostic factors. Sensitivity analyses in other inverse probability of treatment weighting models and the propensity score matching model showed similar results. Patients undergoing no.10 lymph node dissection showed improved survival compared to those without. No.10 lymph node dissection is recommended during total gastrectomy for patients with Borrmann type 4 gastric cancer.© 2023. Springer Nature Limited.