对于胃腺癌，准确的淋巴结分期比T2分类的亚分类具有更大的预后重要性。

Accurate lymph node staging is of greater prognostic importance than subclassification of the T2 category for gastric adenocarcinoma.

作者信息

Sarela Abeezar I, Turnbull Alan D, Coit Daniel G, Klimstra David, Brennan Murray F, Karpeh Martin S

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

出版信息

Ann Surg Oncol. 2003 Aug;10(7):783-91. doi: 10.1245/aso.2003.09.009.

DOI:10.1245/aso.2003.09.009

Abstract

BACKGROUND

Examination of 15 or more lymph nodes is necessary for accurate staging of gastric adenocarcinoma. This study examined whether prognostic discrimination is improved by distinguishing between pT2 tumors limited to the muscularis propria (MP) and those extending to subserosa (SS).

METHODS

A single-institution, prospectively maintained database for 1985-2000 was reviewed for patients who had had R0 resection of pT2 gastric carcinoma.

RESULTS

There were 161 patients with MP and 201 patients with SS. The prevalence of nodal metastasis was significantly lower with MP than with SS (47% vs. 66%, respectively; P <.001). As compared with MP, SS was associated with a similar prevalence of pN1 (44% vs. 43%) but a significantly higher prevalence of pN2 or pN3 (3% vs. 23%; P <.001). Five-year survival was significantly greater for patients with MP than with SS (64% vs. 49%; P =.005). On multivariate analyses, however, only the pN category and tumor site were independently significant prognostic factors. With accurate nodal staging, patients with MP or SS had similar survival in association with pN0 (90% vs. 86%) or pN1 (56% vs. 44%). pN2 or pN3 were mainly limited to SS tumors and these patients had poor survival (26% and 0%).

CONCLUSION

For pT2 gastric adenocarcinoma, the depth of mural invasion was not an independently significant prognostic factor.

摘要

背景

对于胃腺癌进行准确分期，检查15个或更多淋巴结是必要的。本研究探讨了通过区分局限于固有肌层（MP）的pT2肿瘤和延伸至浆膜下（SS）的肿瘤，预后判别是否会得到改善。

方法

回顾了一个单机构前瞻性维护的1985 - 2000年数据库中接受pT2胃癌R0切除的患者。

结果

有161例固有肌层受累患者和201例浆膜下受累患者。固有肌层受累患者的淋巴结转移发生率显著低于浆膜下受累患者（分别为47%和66%；P <.001）。与固有肌层受累相比，浆膜下受累患者的pN1发生率相似（44%对43%），但pN2或pN3发生率显著更高（3%对23%；P <.001）。固有肌层受累患者的5年生存率显著高于浆膜下受累患者（64%对49%；P =.005）。然而，多因素分析显示，只有pN分类和肿瘤部位是独立的显著预后因素。在准确的淋巴结分期情况下，固有肌层受累或浆膜下受累患者在pN0（90%对86%）或pN1（56%对44%）时的生存率相似。pN2或pN3主要局限于浆膜下受累肿瘤，这些患者生存率较差（分别为26%和0%）。

结论

对于pT2胃腺癌，壁层浸润深度不是独立的显著预后因素。