Department of Gastroenterologic Surgery, Affiliated Tumor Hospital of Harbin Medical University, Harbin, China.
World J Surg. 2009 Nov;33(11):2383-8. doi: 10.1007/s00268-009-0214-0.
The classification of lymph node metastasis in patients with gastric cancer is still controversial. Our aim was to evaluate the relative merits of four staging systems of lymph node metastasis.
In our study, the nodal status was classified according to the 5th edition of the tumor node metastasis (TNM) system, the Japanese Classification of Gastric Carcinoma (JCGC), the ratio of metastatic lymph nodes, and the size of the largest metastatic lymph node. Each staging system was scored as good (+2), fair (+1), or poor (0) with respect to the theoretical value (extent of the anatomical lymphatic tumor spread), convenience (simplicity), surgical applicability (extent of lymph node dissection), and prognostic value (ability to predict survival rate).
In the multivariate analysis including the four staging systems and other potential prognostic factors, stepwise Cox regression revealed that the ratio of metastatic lymph nodes was the most independent prognostic factor. The TNM, ratio, and size systems were convenient because they had no consideration for the location of the tumor and lymph node. Although the JCGC system had advantages in theoretical value and surgical application, it was most optional due to the complexity of the system.
Although all different staging systems are comparable, the metastatic lymph node ratio system is convenient, reproducible, and has the highest ability to predict survival.
胃癌患者淋巴结转移的分类仍存在争议。我们的目的是评估四种淋巴结转移分期系统的相对优点。
在我们的研究中，根据肿瘤淋巴结转移（TNM）第 5 版、日本胃癌分类（JCGC）、转移淋巴结比例和最大转移淋巴结大小对淋巴结状态进行分类。每个分期系统根据理论值（解剖性淋巴肿瘤扩散程度）、便利性（简单性）、手术适用性（淋巴结清扫范围）和预后价值（预测生存率的能力）进行评分，分别为良好（+2）、中等（+1）或较差（0）。
在包括四个分期系统和其他潜在预后因素的多因素分析中，逐步 Cox 回归显示转移淋巴结比例是最独立的预后因素。TNM、比例和大小系统很方便，因为它们没有考虑肿瘤和淋巴结的位置。尽管 JCGC 系统在理论价值和手术应用方面具有优势，但由于系统的复杂性，它是最可选的。
尽管所有不同的分期系统都具有可比性，但转移淋巴结比例系统方便、可重复，并且具有最高的生存预测能力。
