Hidaka Hideki, Eto Tadaaki, Maehara Naoki, Jimi Seiichiro, Hotokezaka Masayuki, Chijiiwa Kazuo
Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, Miyazaki, Japan.
Hepatogastroenterology. 2008 Nov-Dec;55(88):2269-72.
BACKGROUND/AIMS: Lymph node metastasis (pN) is one of the most significant prognostic factors in patients with gastric cancer. The pN classification of the Japanese Gastric Cancer Association (JGCA) is based on the anatomical site of metastatic nodes from the primary tumor, whereas that of the International Union Against Cancer (UICC) is based on the number of nodes involved. The purpose of this study was to determine which system is more useful for predicting patient outcomes.
From 1992 to 2002, a total of 318 patients at our hospital underwent surgical resection with lymph node dissection for primary gastric cancer. Their medical records were examined, and the overall survival rates were compared between the two pN classification systems.
Under the JGCA system, there was a significant difference in patient survival between pN0 and pN1 and between pN1 and pN2 but not between pN2 and pN3. Under the UICC-TNM system, there was a significant difference in patient survival between all pN classes. When the JGCA-pN1 and JGCA-pN2 classes were regrouped as UICC-pN1 and UICC-pN2-3, respectively, the survival rate was still better for the UICC-pN1 class than for the UICC-pN2-3 class.
The better differentiation of outcomes by the UICC-pN system suggests that the number of metastatic lymph nodes is more important than the anatomical site in predicting outcomes.
背景/目的：淋巴结转移（pN）是胃癌患者最重要的预后因素之一。日本胃癌协会（JGCA）的pN分类基于原发肿瘤转移淋巴结的解剖部位，而国际抗癌联盟（UICC）的pN分类则基于受累淋巴结的数量。本研究的目的是确定哪种系统在预测患者预后方面更有用。
1992年至2002年，我院共有318例原发性胃癌患者接受了手术切除及淋巴结清扫。检查他们的病历，并比较两种pN分类系统下的总生存率。
在JGCA系统中，pN0和pN1之间以及pN1和pN2之间患者生存率存在显著差异，但pN2和pN3之间无显著差异。在UICC-TNM系统中，所有pN分级之间患者生存率均存在显著差异。当将JGCA-pN1和JGCA-pN2分级分别重新归类为UICC-pN1和UICC-pN2-3时，UICC-pN1分级的生存率仍高于UICC-pN2-3分级。
UICC-pN系统对预后的区分更好，这表明在预测预后方面，转移淋巴结的数量比解剖部位更重要。
