Yu Jun-xiu, Wu Yu-lian, Shen Hong-wei, Dong Xin, Su Kun-lun
Department of Surgery, Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou 310009, China.
Zhonghua Zhong Liu Za Zhi. 2005 Oct;27(10):602-5.
To establish a preoperative scoring system to predict the lymph node metastases (N) in gastric cancers.
The clinicopathologic data of 291 cases with gastric cancer were analyzed retrospectively. The factors influencing significantly actual lymph node status (pN) were selected through the univariate and the multivariate analysis, and the score of each factor was identified. Scores predicting different N stages were identified using receiver operating characteristic curves. The N stages defined by the score system were compared with the actual pN status using kappa statistics and diagnostic test.
Tumor size, depth of invasion and histopathological types were selected to establish the scoring system. According to this score system, scores 0-4 predict N0, scores 5-7 predict N1, scores 8-9 predict N2 and scores 10-13 predict N3. There was a good agreement between N stages predicted by the scoring system and the actual pN status (weighted kappa = 0.605, u = 14.548, P < 0.0001). The crude agreement, positive predictive value and negative predictive value of the scoring system were 82.8%, 65.6% and 88.5%, respectively.
The scoring system can provide accurate and reliable information to predict the lymph node metastases of gastric cancers preoperatively. It is simple and practical to use in clinical work and can help surgeons to choose an optimal extent of lymph node dissection for gastric cancer.
建立一种术前评分系统以预测胃癌的淋巴结转移（N）情况。
回顾性分析291例胃癌患者的临床病理资料。通过单因素和多因素分析选择对实际淋巴结状态（pN）有显著影响的因素，并确定各因素的评分。使用受试者工作特征曲线确定预测不同N分期的评分。采用kappa统计量和诊断试验将评分系统定义的N分期与实际pN状态进行比较。
选择肿瘤大小、浸润深度和组织病理学类型建立评分系统。根据该评分系统，0 - 4分预测N0，5 - 7分预测N1，8 - 9分预测N2，10 - 13分预测N3。评分系统预测的N分期与实际pN状态之间具有良好的一致性（加权kappa = 0.605，u = 14.548，P < 0.0001）。该评分系统的粗一致性、阳性预测值和阴性预测值分别为82.8%、65.6%和88.5%。
该评分系统可为术前预测胃癌淋巴结转移提供准确可靠的信息。在临床工作中使用简单实用，可帮助外科医生为胃癌选择最佳的淋巴结清扫范围。
