Fielding L P, Arsenault P A, Chapuis P H, Dent O, Gathright B, Hardcastle J D, Hermanek P, Jass J R, Newland R C
Yale University School of Medicine, St Mary's Hospital, Waterbury, Connecticut 06706.
J Gastroenterol Hepatol. 1991 Jul-Aug;6(4):325-44. doi: 10.1111/j.1440-1746.1991.tb00867.x.
The purpose of tumour staging for colorectal cancer (CRC) is to help define clinical management, facilitate communication between physicians, provide a basis for stratification and analysis of treatment results in prospective studies, and provide some prognostic information for patients and their families. The World Congresses of Gastroenterology, Digestive Endoscopy, and Coloproctology, Working Party on staging for CRC studied six commonly used systems to review their strengths and weaknesses. Although it was concluded that defining a new staging system was unnecessary, it was recognized that there is a need to define a terminology to describe the full anatomic extent of spread of CRC. Furthermore, we note that there are several additional features, derived from both clinical and pathology information, which have had prognostic significance shown by appropriately constructed multivariate analyses and which can be used to formulate a more accurate prognostic index than that provided by a description of anatomical tumour spread. Thus the Working Party came to two principal conclusions. First, a standard format should be adopted for the collection of the essential data required for prospective studies, and we recommend the 'International Documentation System (IDS) for CRC' for this purpose. Second, a nomenclature which describes the full anatomical extent of tumour spread and residual tumour status in CRC has been defined and should be adopted, from which all currently used staging systems can be derived. We have called this nomenclature the 'International Comprehensive Anatomical Terminology (ICAT) for CRC'. In the event that these recommendations are adopted, we envision that there will be improved clarity in the documentation of treatment outcome for patients with CRC and improved communication of results derived from prospective studies. Furthermore, an acceptance of IDS and ICAT would set the scene to develop a prognostic index for individual patients with CRC by the expansion of anatomical clinicopathology staging information to include additional factors which have independent prognostic significance.
结直肠癌（CRC）肿瘤分期的目的是帮助确定临床治疗方案，促进医生之间的沟通，为前瞻性研究中治疗结果的分层和分析提供依据，并为患者及其家属提供一些预后信息。世界胃肠病学、消化内镜和结直肠外科学会CRC分期工作小组研究了六种常用系统，以评估其优缺点。虽然得出结论认为没有必要定义一个新的分期系统，但人们认识到需要定义一种术语来描述CRC扩散的完整解剖范围。此外，我们注意到，从临床和病理信息中得出的几个额外特征，经适当构建的多变量分析显示具有预后意义，可用于制定比解剖学肿瘤扩散描述更准确的预后指数。因此，工作小组得出了两个主要结论。第一，应采用标准格式收集前瞻性研究所需的基本数据，为此我们推荐使用“CRC国际文档系统（IDS）”。第二，已经定义并应采用一种命名法，用于描述CRC中肿瘤扩散的完整解剖范围和残余肿瘤状态，所有目前使用的分期系统均可从中推导得出。我们将这种命名法称为“CRC国际综合解剖学术语（ICAT）”。如果这些建议被采纳，我们预计CRC患者治疗结果的记录将更加清晰，前瞻性研究结果的交流也将得到改善。此外，接受IDS和ICAT将为通过扩展解剖临床病理分期信息以纳入具有独立预后意义的其他因素，来为个体CRC患者制定预后指数奠定基础。
