Park Do Joong, Kong Seong-Ho, Lee Hyuk-Joon, Kim Woo Ho, Yang Han-Kwang, Lee Kuhn Uk, Choe Kuk Jin
Department of Surgery, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.
Surgery. 2007 Jun;141(6):757-63. doi: 10.1016/j.surg.2007.01.023. Epub 2007 May 4.
We investigated prognostic differences according to nodal status in patients with pT2a and pT2b stage gastric cancers.
The clinicopathologic outcomes of 1118 patients who underwent curative resection and had 15 or more lymph nodes evaluated for pT2 stage gastric cancers between 1986 and 1996 were reviewed retrospectively. Of the study group, 442 (39.5%) patients had pT2a stage gastric cancers and 676 (60.5%) had pT2b stage gastric cancers.
The rates of lymph node metastasis for the pTa and pT2b groups were 53.8% and 71.0%, respectively (P < .001). The disease-specific 5-year survival rate of patients with pT2a cancers was significantly longer than for those with pT2b cancers (85.5% vs 55.7%, P < .001). The prognosis of patients with pT2a gastric cancers was significantly better than that of patients with pT2b cancers on any pN stage (P < .001). Multivariate analysis identified age, pT, and pN stages as independent prognostic factors for patients with pT2 gastric cancers. Patients with pT2aN0 (stage IB) cancers showed the best survival. Patents with pT2aN1 (stage II) and pT2bN0 (stage IB) cancers had similar survival rates, as did patients with pT2aN2 (stage IIIA) and pT2bN1 (stage II) cancers.
The subclassification of pT2 gastric cancers into pT2a or pT2b is necessary to demonstrate their different prognoses. We propose that the current stage grouping should be modified to better represent the prognosis for patients with stage pT2 gastric cancers.
我们研究了pT2a期和pT2b期胃癌患者根据淋巴结状态的预后差异。
回顾性分析了1986年至1996年间1118例行根治性切除且对15枚或更多淋巴结进行评估的pT2期胃癌患者的临床病理结果。研究组中，442例（39.5%）为pT2a期胃癌患者，676例（60.5%）为pT2b期胃癌患者。
pT2a组和pT2b组的淋巴结转移率分别为53.8%和71.0%（P<0.001）。pT2a期癌症患者的疾病特异性5年生存率显著高于pT2b期癌症患者（85.5%对55.7%，P<0.001）。在任何pN分期下，pT2a期胃癌患者的预后均显著优于pT2b期癌症患者（P<0.001）。多因素分析确定年龄、pT和pN分期为pT2期胃癌患者的独立预后因素。pT2aN0（IB期）癌症患者的生存率最佳。pT2aN1（II期）和pT2bN0（IB期）癌症患者的生存率相似，pT2aN2（IIIA期）和pT2bN1（II期）癌症患者的生存率也相似。
将pT2期胃癌细分为pT2a或pT2b对于显示其不同预后是必要的。我们建议修改当前的分期分组，以更好地反映pT2期胃癌患者的预后。
