Department of Medical Oncology, Dr.Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
Dig Dis Sci. 2011 Nov;56(11):3226-34. doi: 10.1007/s10620-011-1721-z. Epub 2011 Jun 10.
The prognostic significance of the subclassification of pT2 tumors and the association of these categories with other clinicopathological factors in gastric cancer patients were investigated.
A total of 224 patients with pT2 gastric cancer who had undergone curative gastrectomy and lymph node dissection were retrospectively analyzed. The prognostic role of the subclassification of pT2 tumors was evaluated by univariate and multivariate analysis.
Of 224 patients, 75 (33.5%) were classified as having pT2a tumors and 149 (66.5%) as having pT2b tumors. The prevalence of large-sized tumors (P < 0.003), lymph node involvement (P < 0.018), and lymphatic (P = 0.016), blood vessel (P = 0.001), and perineural invasion (P = 0.001) was significantly higher for pT2b tumors than for pT2a tumors. The rate of recurrence for pT2a cancers was significantly lower than that for pT2b cancers (P = 0.001).Median overall survival (OS) times and three-year OS of patients with a pT2b tumor were significantly worse than for patients with a pT2a tumor (P < 0.001).When patients were analyzed according to lymph node involvement, the prognosis of patients with pT2aN(1) cancers was significantly better than that of patients with pT2bN(1) (P < 0.001). Multivariate analysis indicated that the pT2 subdivision was an independent prognostic factor for OS (P = 0.006), as were pN stage, clinical stage, and recurrence.
Our results showed that subclassification of pT2 tumors into pT2a or pT2b was an important prognostic indicator for patients with pT2 gastric cancers who underwent curative gastrectomy. In the TNM staging system, subdivision of pT2 tumors should be undertaken routinely to detect gastric cancer patients who have a poor prognosis and to define patients more accurately in terms of their mortality after curative resection in accordance with the new 2010 AJCC TNM staging classification. This may also help as a guide to more appropriate therapy for tumors with subserosal invasion (old pT2b or new pT3).
本研究旨在探讨 pT2 肿瘤的亚分类与胃癌患者其他临床病理因素的关系及其预后意义。
回顾性分析 224 例接受根治性胃切除术和淋巴结清扫术的 pT2 胃癌患者。采用单因素和多因素分析评估 pT2 肿瘤亚分类的预后作用。
224 例患者中，75 例（33.5%）为 pT2a 肿瘤，149 例（66.5%）为 pT2b 肿瘤。与 pT2a 肿瘤相比，pT2b 肿瘤的大肿瘤（P<0.003）、淋巴结受累（P<0.018）、淋巴管（P=0.016）、血管（P=0.001）和神经周围侵犯（P=0.001）的发生率更高。pT2a 癌的复发率明显低于 pT2b 癌（P=0.001）。pT2b 肿瘤患者的中位总生存期（OS）和 3 年 OS 明显差于 pT2a 肿瘤患者（P<0.001）。当根据淋巴结受累情况对患者进行分析时，pT2aN(1) 癌症患者的预后明显优于 pT2bN(1) 患者（P<0.001）。多因素分析表明，pT2 亚分类是 OS 的独立预后因素（P=0.006），pN 分期、临床分期和复发也是 OS 的独立预后因素。
我们的研究结果表明，pT2 肿瘤的亚分类为 pT2a 或 pT2b 是接受根治性胃切除术的 pT2 胃癌患者的重要预后指标。在 TNM 分期系统中，应常规对 pT2 肿瘤进行亚分类，以发现预后不良的胃癌患者，并根据新的 2010 AJCC TNM 分期分类更准确地定义患者在根治性切除术后的死亡率。这也有助于为浆膜下侵犯（旧的 pT2b 或新的 pT3）的肿瘤提供更合适的治疗指导。
