Surgical Department, University Hospital Heidelberg, INF 110, Heidelberg, 69120, Germany.
Langenbecks Arch Surg. 2012 Jan;397(1):45-55. doi: 10.1007/s00423-011-0805-8. Epub 2011 May 20.
The usefulness and prognostic impact of a pretherapeutic clinical staging is still a matter of discussion. However, a pretherapeutic estimation of the prognosis would be essential to adjust the patient's therapy. Our aim was to compare clinical and histopathological staging and to analyze the predictive value of routine clinical staging and its significance for the individualization of treatment.
We analyzed the data of 368 patients treated with gastric cancer in the University of Heidelberg, Department of Surgery, from January 2001 to June 2009. Pretherapeutic parameters including sex, age, cTNM, grading, Laurén classification, tumor localization, as well as posttherapeutic parameters were analyzed, and their impact for survival was evaluated. Follow-up data was obtained for all patients (2.17% lost to follow-up).
The overall accuracy was 64.1% for pT category, 54.5% for pN category, and 80.3% for M category for the primary resected patients. For the patients treated neoadjuvantly, the overall accuracy was 21.8% for the pT category, 58.0% for the pN category, and 80.0% for the M category. The prognosis was associated to the age (p = 0.017), tumor localization (p < 0.001), grading (p = 0.041), cT category (p < 0.001), cN category (p < 0.001), and cM category (p = 0.001). The multivariate analysis, including pre- and postoperative factors, revealed tumor localization (p = 0.002), cN category (p = 0.019), and metastatic lymph node rate (p < 0.001) as independent prognostic factors.
The accordance between clinical and histopathological staging is limited, but nevertheless pretherapeutic parameters have a high prognostic impact and could be used for individualized therapy planning. The relevant pretherapeutic prognostic factors can all be determined by routine clinical staging including CT and endoscopy. Consequently pretherapeutic prognostic evaluation and therapy planning seem to be feasible with routine staging methods.
治疗前临床分期的有用性和预后影响仍然存在争议。然而，对预后进行治疗前评估对于调整患者的治疗至关重要。我们的目的是比较临床和组织病理学分期，并分析常规临床分期的预测价值及其对治疗个体化的意义。
我们分析了 2001 年 1 月至 2009 年 6 月在海德堡大学外科接受胃癌治疗的 368 例患者的数据。分析了治疗前的参数，包括性别、年龄、cTNM、分级、Laurén 分类、肿瘤定位以及治疗后的参数，并评估了其对生存的影响。所有患者均获得随访数据（2.17%失访）。
对于原发性切除患者，pT 分期的总体准确率为 64.1%，pN 分期为 54.5%，M 分期为 80.3%。对于接受新辅助治疗的患者，pT 分期的总体准确率为 21.8%，pN 分期为 58.0%，M 分期为 80.0%。预后与年龄（p=0.017）、肿瘤定位（p<0.001）、分级（p=0.041）、cT 分期（p<0.001）、cN 分期（p<0.001）和 cM 分期（p=0.001）有关。包括术前和术后因素的多变量分析显示，肿瘤定位（p=0.002）、cN 分期（p=0.019）和转移淋巴结率（p<0.001）是独立的预后因素。
临床分期与组织病理学分期之间的一致性有限，但治疗前参数具有高度的预后影响，可以用于个体化治疗计划。包括 CT 和内窥镜检查在内的常规临床分期可以确定所有相关的治疗前预后因素。因此，通过常规分期方法进行治疗前预后评估和治疗计划似乎是可行的。
