验证新的 AJCC TNM 分期系统在大型胃癌患者队列中的应用（n = 2155）：重点关注 T 分期。

Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients (n = 2,155): focus on the T category.

机构信息

Clinica Chirurgica II, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.

出版信息

Eur J Surg Oncol. 2011 Sep;37(9):779-85. doi: 10.1016/j.ejso.2011.06.001. Epub 2011 Jul 2.

DOI:10.1016/j.ejso.2011.06.001

PMID:21726975

Abstract

BACKGROUND

The prognostic value of T subclassification in patients with gastric carcinoma has been just implemented in the new AJCC TNM staging system, which has reclassified T2a and T2b into T2 and T3 tumors, respectively. The aim of the present study was to validate the prognostic significance of the new T categorization within the frame of the latest TNM staging system.

METHODS

We retrospectively reviewed the records of 686 T2/T3 patients among 2155 subjects who underwent radical resection for gastric carcinoma at six Italian centers from 1988 through 2006.

RESULTS

Upon multivariate analysis, the new T categories, extent of lymph node dissection (D) and patient's age were retained by the survival model as independent prognostic factors. In particular, the death risk for patients with T3 tumors was higher than that of patients with T2 tumors (HR: 1.42, P = 0.005). Among the 686 patients previously classified as having T2 tumors, patients with T2 and T3 disease were 270 (39.4%) and 416 (60.6%), respectively. After a median follow-up of 55 months, the 5-year overall survival rates were 67.3% and 52.3% for patients with T2 and T3 tumors, respectively (P < 0.001). The survival advantage for the T2 as compared to T3 category was maintained even when N0 and N+ patients were separately considered (P = 0.0154 and P < 0.001, respectively).

CONCLUSIONS

Our data confirm the prognostic difference between the newly proposed T2 and T3 categories, which should be implemented in the routine clinical practice to improve risk stratification of patients with gastric cancer.

摘要

背景

新的 AJCC TNM 分期系统已经将 T 亚分类应用于胃癌患者的预后评估，将 T2a 和 T2b 分别重新分类为 T2 和 T3 肿瘤。本研究旨在验证新的 T 分类在最新 TNM 分期系统中的预后意义。

方法

我们回顾性分析了 6 个意大利中心在 1988 年至 2006 年间对 2155 例接受根治性胃切除术的 T2/T3 患者的记录。

结果

多因素分析显示，新的 T 分类、淋巴结清扫程度（D）和患者年龄是生存模型中保留的独立预后因素。特别是，T3 肿瘤患者的死亡风险高于 T2 肿瘤患者（HR：1.42，P=0.005）。在之前被归类为 T2 肿瘤的 686 例患者中，T2 和 T3 疾病患者分别为 270 例（39.4%）和 416 例（60.6%）。中位随访 55 个月后，T2 和 T3 肿瘤患者的 5 年总生存率分别为 67.3%和 52.3%（P<0.001）。即使分别考虑 N0 和 N+患者，T2 与 T3 分类之间的生存优势仍然存在（P=0.0154 和 P<0.001）。