Pan Yuan, Liang Han, Xue Qiang, Zhang Ru-Peng, Cui Qing-Hao, Liu Ning, Wang Bao-Gui
Department of Gastrointestinal Surgical Oncology, Key Laboratory of Tianjin Cancer Prevention and Management, Cancer Hospital, Tianjin Medical University, Tianjin 300060, China.
Zhonghua Zhong Liu Za Zhi. 2008 May;30(5):376-80.
To compare the correlation of prognosis with UICC or JGCA lymph node staging criteria for gastric cancer and evaluate the value of application of those two TNM staging systems in prognosis prediction.
From January 1996 to December 2005, 395 gastric cancer patients who underwent D2 or D2 plus radical gastrectomy with > or = 15 lymph nodes removed were enrolled into this study. The data were analyzed by both UICC and JGCA lymph node staging criteria, respectively. Kaplan-Meier method was applied to analyze the survival rates, and Log-rank test was performed to assess the statistical significance among groups.
Compared with the survival curve based on JGCA lymph node staging criteria, UICC lymph node staging system showed a much more significant difference among N subgroups, and similar result was also found in the patients with T3 disease. The N subgroups stratified by UICC criteria were re-staged with JGCA, while the N subgroups by JGCA criteria with UICC. Though the difference among subgroups were not statistically significant in either group, it was greater based on UICC criteria than that based on JGCA. No significant difference was found in the 5-year survival rates of stage I , II, III and IV based on either UICC or JGCA TNM staging criteria.
Our results show that UICC staging system is more predictive and relevant to prognosis than JGCA staging system for gastric cancer, and D2 or D2 plus radical gastrectomy with at least or more than 15 lymph nodes removed is required when UICC-TNM gastric cancer staging criteria is applied.
比较国际抗癌联盟(UICC)和日本胃癌协会(JGCA)的胃癌淋巴结分期标准与预后的相关性,并评估这两种TNM分期系统在预后预测中的应用价值。
选取1996年1月至2005年12月期间395例行D2或D2+根治性胃切除术且清扫淋巴结≥15枚的胃癌患者纳入本研究。分别依据UICC和JGCA淋巴结分期标准对数据进行分析。采用Kaplan-Meier法分析生存率,并用Log-rank检验评估组间差异的统计学意义。
与基于JGCA淋巴结分期标准的生存曲线相比,UICC淋巴结分期系统在N亚组间差异更为显著,在T3期患者中也得到类似结果。将依据UICC标准分层的N亚组用JGCA标准重新分期,而依据JGCA标准分层的N亚组用UICC标准重新分期。尽管两组亚组间差异均无统计学意义,但基于UICC标准的差异大于基于JGCA标准的差异。依据UICC或JGCA TNM分期标准,Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者的5年生存率均无显著差异。
我们的结果表明,对于胃癌,UICC分期系统比JGCA分期系统对预后更具预测性且相关性更强,应用UICC-TNM胃癌分期标准时,需要行D2或D2+根治性胃切除术且清扫至少15枚或更多淋巴结。