Nitti D, Marchet A, Mocellin S, Rossi G M, Ambrosi A, Mencarelli R
Clinica Chirurgica II, Department of Oncological and Surgical Sciences, University of Padua, Italy.
Br J Surg. 2009 Apr;96(4):398-404. doi: 10.1002/bjs.6487.
This study was designed to evaluate the prognostic value of tumour stage T2 subcategorization (T2a and T2b) in patients with gastric carcinoma.
Clinicopathological details of a prospective series of patients who had radical resection of gastric adenocarcinoma in a single institution were analysed. Univariable and multivariable survival analyses were performed with the log rank test and Cox's model respectively.
Of 373 evaluable patients, 49 (13.1 per cent) had a T2a and 143 (38.3 per cent) a T2b tumour. At a median follow-up of 35.5 months, the 5-year overall survival rate was 73 and 31.1 per cent for patients with T2a and T2b lesions respectively (P < 0.001). On multivariable analysis, T stage remained an independent prognostic factor. Compared with T1a, the mortality risk for patients with T1b (hazard ratio (HR) 1.00; P = 0.992) and T2a (HR 0.97; P = 0.916) tumours was similar; by contrast, the risk of death associated with T2b (HR 1.81; P = 0.031) and T3 (HR 1.89; P = 0.038) lesions was significantly greater than for T1a tumours.
Subclassification of T2 tumours should be undertaken routinely in order to stratify patients with gastric cancer more accurately in terms of their mortality risk.
本研究旨在评估肿瘤分期T2亚分类（T2a和T2b）对胃癌患者的预后价值。
分析了在单一机构接受胃腺癌根治性切除术的一系列前瞻性患者的临床病理细节。分别采用对数秩检验和Cox模型进行单变量和多变量生存分析。
在373例可评估患者中，49例（13.1%）为T2a肿瘤，143例（38.3%）为T2b肿瘤。中位随访35.5个月时，T2a和T2b病变患者的5年总生存率分别为73%和31.1%（P<0.001）。多变量分析显示，T分期仍然是一个独立的预后因素。与T1a相比，T1b（风险比（HR）1.00；P = 0.992）和T2a（HR 0.97；P = 0.916）肿瘤患者的死亡风险相似；相比之下，T2b（HR 1.81；P = 0.031）和T3（HR 1.89；P = 0.038）病变患者的死亡风险显著高于T1a肿瘤患者。
应常规进行T2肿瘤的亚分类，以便更准确地根据死亡风险对胃癌患者进行分层。
