Atalay C, Kanliöz M, Altinok M
Department of General Surgery; Ankara Oncology Hospital, Ankara, Turkey.
Neoplasma. 2002;49(5):323-8.
Tumor node metastases staging systems have been widely utilized to predict the prognosis of gastric cancer patients. The current study aimed to compare a prognostic scoring system to tumor node metastases 1992 and 1997 staging systems in predicting the outcome of resectable gastric cancer patients. Patients treated between 1996-1998 were retrospectively evaluated. Tumor depth in the gastric wall, anatomical location and number of metastatic lymph nodes, metastatic to retrieved lymph node ratio, extent of surgical resection, tumor location, type of lymph node dissection, macroscopic appearence and histologic type of tumor were recorded and patients were divided into groups I-III due to their scores. Patients were also staged according to both tumor node metastases systems. Survival data was analyzed by Kaplan-Meier method. For the comparison of power of the three systems in predicting survival, log-rank and Cox regression analysis were respectively used for univariate and multivariate analysis. 163 resectable gastric cancer patients were evaluated. Median follow-up and survival times were 26 and 23 months respectively. Overall 5-year survival was 37.6%. The number of patients in prognostic scoring groups I, II and III was 44, 109 and 10, respectively. According to tumor node metastases 1992 system, 13, 43, 101 and 6 patients were in stages I, II, III and IV while there were 13, 38, 78 and 34 patients in respective stages in tumor node metastases 1997 system. Although tumor node metastases 1992 (p=0.0088), 1997 (p=0.0029) and prognostic scoring systems (p=0.0006) significantly predicted the survival of patients in univariate analysis, prognostic scoring system was found to be superior compared to other two systems in multivariate analysis (p=0.0002). Prognostic scoring system is a practical, reliable and reproducible method that could be used as an adjunct to tumor node metastases systems in predicting survival of resectable gastric cancer patients.
肿瘤淋巴结转移分期系统已被广泛用于预测胃癌患者的预后。本研究旨在比较一种预后评分系统与1992年和1997年肿瘤淋巴结转移分期系统在预测可切除胃癌患者预后方面的效果。对1996年至1998年期间接受治疗的患者进行回顾性评估。记录胃壁肿瘤深度、解剖位置、转移淋巴结数量、转移淋巴结与检出淋巴结的比例、手术切除范围、肿瘤位置、淋巴结清扫类型、肿瘤大体外观和组织学类型，并根据患者得分将其分为I - III组。患者还根据两种肿瘤淋巴结转移系统进行分期。采用Kaplan - Meier法分析生存数据。为比较三种系统预测生存的能力，分别使用对数秩检验和Cox回归分析进行单因素和多因素分析。对163例可切除胃癌患者进行了评估。中位随访时间和生存时间分别为26个月和23个月。总体5年生存率为37.6%。预后评分I组、II组和III组的患者数量分别为44例、109例和10例。根据1992年肿瘤淋巴结转移系统，I期、II期、III期和IV期的患者分别为13例、43例、101例和6例；而根据1997年肿瘤淋巴结转移系统，各期患者分别为13例、38例、78例和34例。虽然在单因素分析中，1992年肿瘤淋巴结转移系统（p = 0.0088）、1997年肿瘤淋巴结转移系统（p = 0.0029）和预后评分系统（p = 0.0006）均显著预测了患者的生存情况，但在多因素分析中，预后评分系统被发现优于其他两种系统（p = 0.0002）。预后评分系统是一种实用、可靠且可重复的方法，可作为肿瘤淋巴结转移系统的辅助手段，用于预测可切除胃癌患者的生存情况。
