Lee Wei-Jei, Hong Rey-Long, Lai I-Ru, Chen Chaung-Nien, Lee Po-Huang, Chung King-Chang
Department of Surgery, En-Chu Kong Hospital, National Taiwan University Hospital, Taipei, Taiwan.
Hepatogastroenterology. 2002 May-Jun;49(45):860-4.
BACKGROUND/AIMS: The International Union Against Cancer (UICC) TNM staging system defined a new system for classifying gastric cancer, based on the number of metastatic nodes (1997). However, the advantage of the new system is still a matter of debate. The aim of the present study is to compare the new system with the old one (1987), which is based on the location of positive lymph nodes.
We analyzed the survival of 608 patients with curative resection of their gastric cancer. The average number of resected and involved lymph nodes for each resected patient was 31.4 and 7.7. Comparison of these two systems was carried out to determine which classification was more effective. The prognostic value of different lymph node staging systems was also analyzed.
One hundred and thirty-five patients (22.2%) had different N classification and 109 (17.9%) had different TNM staging. There was a significant stepwise decrease of slope of survival curve for each stage, but the new system did not cleanly separate stage II with IIIa at 3 years and stage IIIb with IV at 5 years. Although different lymph node staging systems were able to predict survival, the ratio rather than the number of involved nodes had a more cleanly separated stepwise decrease of slope of survival curve.
The new UICC staging system is not better than the old system for the staging of gastric cancer. The reason is that the category of node number seems not to be appropriate and will be influenced by the extent of lymph node dissection. To overcome this problem, the frequency of involved nodes can be adopted instead of the number.
背景/目的：国际抗癌联盟（UICC）的TNM分期系统基于转移淋巴结数量定义了一种新的胃癌分类系统（1997年）。然而，新系统的优势仍存在争议。本研究的目的是将新系统与基于阳性淋巴结位置的旧系统（1987年）进行比较。
我们分析了608例接受胃癌根治性切除术患者的生存情况。每位接受手术的患者切除和受累淋巴结的平均数量分别为31.4个和7.7个。对这两种系统进行比较以确定哪种分类更有效。还分析了不同淋巴结分期系统的预后价值。
135例患者（22.2%）有不同的N分类，109例（17.9%）有不同的TNM分期。每个阶段的生存曲线斜率均有显著的逐步下降，但新系统在3年时未能清晰区分II期和IIIa期，在5年时未能清晰区分IIIb期和IV期。尽管不同的淋巴结分期系统能够预测生存情况，但受累淋巴结的比例而非数量在生存曲线斜率的逐步下降上有更清晰的区分。
对于胃癌分期，新的UICC分期系统并不优于旧系统。原因是淋巴结数量类别似乎不合适，且会受到淋巴结清扫范围的影响。为克服这一问题，可采用受累淋巴结的频率而非数量。
