de Manzoni Giovanni, Verlato Giuseppe, di Leo Alberto, Guglielmi Alfredo, Laterza Ernesto, Ricci Francesco, Cordiano Claudio
Istituto di Semeiotica Chirurgica, Università di Verona, Verona, Italy.
Gastric Cancer. 1999 Dec;2(4):201-205. doi: 10.1007/s101200050063.
Perigastric lymph node metastases in gastric cancer are classified differently by different staging systems: the distance of positive nodes from the primary tumor is considered by the 1987 International Union Against Cancer (UICC)-TNM system, but not by the Japanese staging system (of the Japanese Research Society for Gastric Cancer [JRSGC]); the new UICC-TNM system of 1997 is based on the number of involved nodes without differentiating perigastric from regional nodes. The aim of the present study was to assess which classification was more useful to predict prognosis in gastric cancer patients with metastases to the perigastric nodes.METHODS: The results for 107 patients with lymph node metastases to the first and second tiers who underwent curative gastrectomy for gastric cancer from March 1988 to October 1997 were analyzed. In particular, we compared the clinical characteristics and the survival probabilities of: (1) patients with metastases to perigastric nodes located within 3 cm from the primary tumor, classified as N1; (2) patients with metastases to perigastric nodes located 3 cm beyond the primary tumor (N2 in the UICC-TNM and N1 in the Japanese classification), classified by us as N1-N2; and (3) patients with metastases to the second tier (classified by us as N2). We also assessed the number of positive nodes dividing the patients into groups according to the 1997 UICC TNM system.RESULTS: On multivariate survival analysis, the mortality risks in the N1 and N1-N2 patients were comparable (relative risk [RR], N1-N2 versus N1, 1.32; 95% confidence interval [CI], 0.53-3.51) and were half the mortality risk in N2 patients (RR, N2 versus N1, 2.52; 95% CI, 1.33-4.79). The N1 and N1-N2 categories, while presenting markedly different distributions in the number of metastatic nodes (patients with more than seven metastatic nodes constituted less than 20% of the N1 group and more than 60% of the N1-N2 group), showed similar prognostic significance.CONCLUSION: In the present series, the distance of perigastric nodes from the primary tumor did not seem to exert a significant effect on prognosis, and the use of a combined classification based on anatomical location (JRSGC) and number of node metastases (UICC-TNM 1997) could be more useful than either system alone for prognostic purposes.
不同的分期系统对胃癌胃周淋巴结转移的分类有所不同：1987年国际抗癌联盟（UICC）-TNM系统考虑阳性淋巴结与原发肿瘤的距离，而日本胃癌研究会（JRSGC）的日本分期系统则不考虑；1997年的新UICC-TNM系统基于受累淋巴结的数量，未区分胃周淋巴结和区域淋巴结。本研究的目的是评估哪种分类方法对预测胃周淋巴结转移的胃癌患者的预后更有用。
分析了1988年3月至1997年10月期间107例行胃癌根治性胃切除术且有第一和第二层淋巴结转移的患者的结果。具体而言，我们比较了以下患者的临床特征和生存概率：（1）胃周淋巴结转移至距原发肿瘤3 cm以内（UICC-TNM系统分类为N1）的患者；（2）胃周淋巴结转移至距原发肿瘤3 cm以外（UICC-TNM系统分类为N2，日本分类为N1）的患者，我们将其分类为N1-N2；（3）第二层淋巴结转移（我们分类为N2）的患者。我们还根据1997年UICC TNM系统评估了阳性淋巴结数量，将患者分组。
多因素生存分析显示，N1和N1-N2患者的死亡风险相当（相对风险[RR]，N1-N2与N1相比，1.32；95%置信区间[CI]，0.53-3.51），是N2患者死亡风险的一半（RR，N2与N1相比，2.52；95%CI，1.33-4.79）。N1和N1-N2类别虽然在转移淋巴结数量上分布明显不同（转移淋巴结超过7个的患者在N1组中占比不到20%，在N1-N2组中占比超过60%），但显示出相似的预后意义。
在本系列研究中，胃周淋巴结与原发肿瘤的距离似乎对预后没有显著影响，基于解剖位置（JRSGC）和淋巴结转移数量（1997年UICC-TNM）的联合分类在预后评估方面可能比单独使用任何一种系统更有用。
