胃癌的淋巴结转移：国际抗癌联盟（UICC）和日本系统的比较。

Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems.

作者信息

Ikeguchi Masahide, Murakami Daiki, Kanaji Shingo, Ohro Shotaro, Maeta Yoshihiko, Yamaguchi Ken-Ichi, Tatebe Shigeru, Kondo Akira, Tsujitani Shun-Ichi, Kaibara Nobuaki

机构信息

Division of Operating Room, Faculty of Medicine, Tottori University, Yonago, Japan.

出版信息

ANZ J Surg. 2004 Oct;74(10):852-4. doi: 10.1111/j.1445-1433.2004.03188.x.

DOI:10.1111/j.1445-1433.2004.03188.x

PMID:15456431

Abstract

BACKGROUND

The pN classification of gastric cancer (GC) in the Japanese system (Japanese Gastric Cancer Association; JGCA) is based on the site and distance of metastatic nodes from the primary tumour. Union International Contra Cancer (UICC) has recently proposed a classification system based on the number of nodes involved (TNM-1997). The aim of the present study is to assess which classification system is more suitable for providing a prognosis in advanced GC with lymph node metastasis.

METHODS

A total of 224 patients who underwent curative gastrectomy (R0: UICC-TNM and Resection A and B: JGCA) and D2 lymphadenectomy between 1990 and 1999, and diagnosed as pT2, pT3 and pT4 GC were enrolled. Patients were followed until the end of 2002. The disease-free survival rates of patients were compared between the two-stage systems (UICC-TNM and JGCA).

RESULTS

Using the JGCA system, there was a significant difference between the two survival curves (pN0 and pN1, P = 0.025; pN1 and pN2, P < 0.001; pN2 and pN3, P = 0.031), but the 5-year survival rate of 27 pN2 patients (32.7%) was not significantly different from that of 14 pN3 patients (34.3%, P = 0.994) using the UICC-TNM. In 47 patients with JGCA pN2, the 5-year survival rate of 18 patients with UICC-TNM pN1 (42.9%) was not significantly different from that of 18 patients with UICC-TNM pN2 (25.2%, P = 0.422) or from that of 11 patients with UICC-TNM pN3 (24.2%; P = 0.383).

CONCLUSIONS

The JGCA system is more suitable for estimating the prognosis of Japanese patients with advanced GC than the UICC-TNM.

摘要

背景

日本胃癌协会（JGCA）的日本胃癌系统中，胃癌（GC）的pN分类基于转移淋巴结距原发肿瘤的部位和距离。国际抗癌联盟（UICC）最近提出了一种基于受累淋巴结数量的分类系统（TNM - 1997）。本研究的目的是评估哪种分类系统更适合为伴有淋巴结转移的进展期胃癌提供预后评估。

方法

选取1990年至1999年间共224例行根治性胃切除术（R0：UICC - TNM，切除A和B：JGCA）及D2淋巴结清扫术，且诊断为pT2、pT3和pT4期胃癌的患者。对患者进行随访至2002年底。比较两种分期系统（UICC - TNM和JGCA）患者的无病生存率。

结果

采用JGCA系统时，两条生存曲线之间存在显著差异（pN0和pN1，P = 0.025；pN1和pN2，P < 0.001；pN2和pN3，P = 0.031），但采用UICC - TNM时，27例pN2患者的5年生存率（32.7%）与14例pN3患者的5年生存率（34.3%，P = 0.994）无显著差异。在47例JGCA pN2患者中，18例UICC - TNM pN1患者的5年生存率（42.9%）与18例UICC - TNM pN2患者的5年生存率（25.2%，P = 0.422）以及11例UICC - TNM pN3患者的5年生存率（24.2%；P = 0.383）均无显著差异。