Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
World J Surg. 2010 Aug;34(8):1840-6. doi: 10.1007/s00268-010-0587-0.
Adequate preoperative evaluation for gastric cancer staging is essential to develop an individualized treatment strategy involving surgery with reduced lymphadenectomy and laparoscopic gastrectomy.
A total of 509 gastric cancer patients with clinical Stage IA or IB disease were divided into two groups: 304 patients were admitted in 2000 or earlier (Group A), and 205 patients were admitted in 2001, when multidetector computed tomography (MD-CT) was available, or later (Group B). We evaluated the accuracy of the preoperative diagnoses of tumor depth, lymph node involvement, and tumor stage.
With respect to tumor depth, 94.5 and 52.8% of patients were staged correctly in cT1 and cT2 patients, respectively. Among both cT1 and cT2 patients, the underestimated rates were lower in Group B than in Group A. For nodal metastasis, 83.2 and 30.0% of patients were staged correctly in cN0 and cN1 patients, respectively. Among the cN0 patients, 82.1 and 84.7% of Group A and Group B patients, respectively, were staged correctly. Among the cN1 patients, none of the patients in Group B was underestimated, while 9.7% of Group A patients were underestimated. There was a significant increase in the percentage of correctly staged patients and a decrease in the percentage of underestimated patients in Group B in comparison to Group A in both cStage IA and cStage IB patients.
Remarkable advances have been observed in the accuracy of preoperative staging in the early stage of gastric cancer. However, it is necessary to continue to develop accurate preoperative and intraoperative diagnostic systems.
充分的术前评估对于胃癌分期至关重要，有助于制定个体化治疗策略，包括减少淋巴结清扫的手术和腹腔镜胃切除术。
共纳入 509 例临床分期为 IA 或 IB 期的胃癌患者，分为两组：2000 年或更早入院的 304 例患者（A 组），以及 2001 年多排螺旋 CT（MD-CT）可用或之后入院的 205 例患者（B 组）。我们评估了术前诊断肿瘤深度、淋巴结转移和肿瘤分期的准确性。
对于肿瘤深度，cT1 和 cT2 患者的分期准确率分别为 94.5%和 52.8%。在 cT1 和 cT2 患者中，B 组低估率均低于 A 组。对于淋巴结转移，cN0 和 cN1 患者的分期准确率分别为 83.2%和 30.0%。在 cN0 患者中，A 组和 B 组的分期准确率分别为 82.1%和 84.7%。在 cN1 患者中，B 组无一例低估，而 A 组有 9.7%低估。与 A 组相比，B 组 IA 期和 IB 期患者中正确分期的患者比例显著增加，低估的患者比例显著减少。
在胃癌的早期阶段，术前分期的准确性取得了显著进展。然而，有必要继续开发准确的术前和术中诊断系统。
