Jung Da Hyun, Kim Jie-Hyun, Lee Yong Chan, Huh Cheal Wung, Youn Young Hoon, Park Hyojin, Lee Sang In, Choi Seung Ho, Noh Sung Hoon
Hepatogastroenterology. 2013 Jul-Aug;60(125):1225-30. doi: 10.5754/hge11579.
BACKGROUND/AIMS: The clinical and prognostic value of the previous node classification of TNM staging in early gastric cancer (EGC) has been less definitive. The aim was to assess the suitability of the revised node staging for prediction of clinical behavior of EGC.
Between 2005 and 2008, 1,845 patients were diagnosed with EGC and underwent surgery at Severance Hospitals. Clinicopathological characteristics were analyzed with comparisons between sixth and seventh TNM staging.
When comparing IB with IIA upstaged based on seventh staging, poor differentiation, signet ring cell, diffuse, undifferentiated types, perineural invasion (PNI), larger size and younger age, were more significantly associated with IIA. Clinicopathological factors were compared between N0/N1 and N2/N3 based on both staging. In mucosal cancer, younger age, diffuse and undifferentiated types were more significantly associated with N2/N3 based on seventh staging. In submucosal cancer, larger size, poor differentiation, signet ring cell, diffuse, undifferentiated types, PNI and deeper submucosal invasion, were more significantly associated with N2/N3 based on seventh staging.
Upstaging in EGC based on the revised TNM staging reflects more aggressive biological behavior of cancer. The new TNM staging system may be informative in prediction of biological behavior of EGC as well as prognosis and survival.
背景/目的：早期胃癌（EGC）中既往TNM分期的淋巴结分类的临床及预后价值尚不明确。本研究旨在评估修订后的淋巴结分期对EGC临床行为预测的适用性。
2005年至2008年间，1845例EGC患者在延世大学Severance医院确诊并接受手术。对临床病理特征进行分析，并比较第六版和第七版TNM分期。
基于第七版分期将IB期与上调后的IIA期进行比较时，低分化、印戒细胞、弥漫性、未分化型、神经周围侵犯（PNI）、肿瘤较大及年龄较轻与IIA期的相关性更为显著。基于两种分期比较N0/N1和N2/N3之间的临床病理因素。在黏膜癌中，基于第七版分期，年龄较轻、弥漫性和未分化型与N2/N3的相关性更为显著。在黏膜下癌中，基于第七版分期，肿瘤较大、低分化、印戒细胞、弥漫性、未分化型、PNI及黏膜下浸润较深与N2/N3的相关性更为显著。
基于修订后的TNM分期对EGC进行分期上调反映了癌症更具侵袭性的生物学行为。新的TNM分期系统在预测EGC的生物学行为以及预后和生存方面可能具有参考价值。
