Potrc Stojan, Skalicky Marjan, Ivanecz Arpad
Department of Abdominal and General Surgery, Maribor Teaching Hospital, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
Wien Klin Wochenschr. 2006;118 Suppl 2:48-51. doi: 10.1007/s00508-006-0552-y.
The aim of our study was to evaluate the accuracy of preoperative TNM staging with endoscopic ultrasound (EUS) in gastric cancer patients in comparison with the pathohistological stage of the resected specimen, and to determine the possible implications of EUS for individualized treatment of gastric cancer patients at our institution.
The study included 82 patients operated for resectable gastric cancer between January 1(st) 2001 and July 1(st) 2003 at the Maribor Teaching Hospital Department of Abdominal and General Surgery. The EUS stage was assessed preoperatively at the Endoscopical Unit, and the pathohistological stage in the resected specimen was determined postoperatively at the Department of Pathologic Morphology according to recommended standards.
Comparison of EUS and pathohistological assessments revealed accuracy of EUS staging for locoregional tumor infiltration (category T) in 68% of patients. The accuracy of EUS staging was 68% for T1, 69% for T2, 69% for T3 and 60% for T4. Lymph nodes (category N) were correctly staged with EUS in 57% of cases. The EUS stage was correct for lymph nodes with no metastases (N-) in 40% of cases, and for lymph nodes with metastases (N+) in 90%. There was no significant difference in accuracy of EUS staging with regard to tumor site (P = 0.768) or tumor size (P = 0.766).
According to our results the accuracy of EUS staging matched pathohistological staging with regard to tumor infiltration and lymph node stage in 68% and 57% of cases respectively. Underestimation of the final T2 and T3 stages as T1 stage by EUS presents a problem regarding the consistency of EUS examination at our institution, particularly with respect to individual treatment for early gastric cancer. The present uncertainty in EUS stage reliability makes it necessary to have a strategy of radical resection with D2 lymphadenectomy in patients within EUS stages T1-T3, with additional CT examinations in more advanced EUS stages in order to visualize the circumstances of tumor growth. Nevertheless, EUS provides an opportunity for the surgeon to gain more insight into the loco-regional circumstances of the gastric tumor process. For development of individual modes of treatment based on EUS staging, a more reliable assessment of EUS stage is mandatory.
我们研究的目的是评估内镜超声（EUS）对胃癌患者术前TNM分期的准确性，并与切除标本的病理组织学分期进行比较，同时确定EUS在我们机构对胃癌患者个体化治疗的可能影响。
该研究纳入了2001年1月1日至2003年7月1日在马里博尔教学医院腹部及普通外科接受可切除胃癌手术的82例患者。术前在内镜科评估EUS分期，术后在病理形态学部门根据推荐标准确定切除标本的病理组织学分期。
EUS与病理组织学评估的比较显示，68%的患者EUS对局部肿瘤浸润（T类）分期准确。T1期EUS分期准确率为68%，T2期为69%，T3期为69%，T4期为60%。57%的病例EUS对淋巴结（N类）分期正确。EUS对无转移淋巴结（N-）分期正确的病例占40%，对有转移淋巴结（N+）分期正确的病例占90%。EUS分期准确性在肿瘤部位（P = 0.768）或肿瘤大小（P = 0.766）方面无显著差异。
根据我们的结果，EUS分期在肿瘤浸润和淋巴结分期方面分别与病理组织学分期相符的病例为68%和57%。EUS将最终的T2和T3期低估为T1期，这在我们机构中存在EUS检查一致性的问题，特别是在早期胃癌的个体化治疗方面。目前EUS分期可靠性的不确定性使得有必要对EUS分期为T1 - T3期的患者采取D2淋巴结清扫的根治性切除策略，对于更晚期的EUS分期患者进行额外的CT检查以观察肿瘤生长情况。然而，EUS为外科医生提供了一个更深入了解胃肿瘤局部情况的机会。为了基于EUS分期制定个体化治疗模式，必须对EUS分期进行更可靠的评估。
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