John Griniatsos, Othon Michail, Nikoletta Dimitriou, Ioannis Karavokyros, 1st Department of Surgery, University of Athens, Medical School, GR 115-27, Athens, Greece.
World J Gastrointest Oncol. 2012 Feb 15;4(2):16-21. doi: 10.4251/wjgo.v4.i2.16.
The 7th TNM classification clearly states that micrometastases detected by morphological techniques (HE stain and immunohistochemistry) should always be reported and calculated in the staging of the disease (pN1mi or M1), while patients in whom micrometastases are detected by non-morphological techniques (e.g., flow cytometry, reverse-transcriptase polymerase chain reaction) should still be classified as N0 or M0. In gastric cancer patients, micrometastases have been detected in lymph nodes, the peritoneal cavity and bone marrow. However, the clinical implications and/or their prognostic significance are still a matter of debate. Current literature suggests that lymph node micrometastases should be encountered for the loco-regional staging of the disease, while skip lymph node micrometastases should also be encountered in the total number of infiltrated lymph nodes. Peritoneal fluid cytology examination should be obligatorily performed in pT3 or pT4 tumors. A positive cytology classifies gastric cancer patients as stage IV. Although a curative resection is not precluded, these patients face an overall dismal prognosis. Whether patients with a positive cytology should be treated similarly to patients with macroscopic peritoneal recurrence should be evaluated further. Gastric cancer cells are detected with high incidence in the bone marrow. However, the published results make comparison of data between groups almost impossible due to severe methodological problems. If these methodological problems are overcome in the future, specific target therapies may be designed for specific groups of patients.
第 7 版 TNM 分类明确指出，通过形态学技术（HE 染色和免疫组织化学）检测到的微转移应始终报告并计入疾病分期（pN1mi 或 M1），而通过非形态学技术（例如流式细胞术、逆转录-聚合酶链反应）检测到微转移的患者仍应归类为 N0 或 M0。在胃癌患者中，已经在淋巴结、腹腔和骨髓中检测到微转移。然而，其临床意义和/或预后意义仍存在争议。目前的文献表明，对于疾病的局部区域分期，应遇到淋巴结微转移，而在受累的淋巴结总数中也应遇到跳跃淋巴结微转移。对于 pT3 或 pT4 肿瘤，应强制性进行腹腔液细胞学检查。细胞学阳性将胃癌患者归类为 IV 期。虽然不排除治愈性切除，但这些患者的总体预后较差。对于细胞学阳性的患者是否应与有肉眼腹膜复发的患者进行类似治疗，应进一步评估。在骨髓中以高发生率检测到胃癌细胞。然而，由于严重的方法学问题，发表的结果使得几乎不可能在各组之间比较数据。如果未来克服了这些方法学问题，可能会为特定患者群体设计特定的靶向治疗。
