Lu Jun, Huang Chang-ming, Zheng Chao-hui, Li Ping, Xie Jian-wei, Wang Jia-bin, Lin Jian-xian, Chen Qi-yue, Cao Long-long, Lin Mi
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou City, China.
PLoS One. 2014 Dec 30;9(12):e115776. doi: 10.1371/journal.pone.0115776. eCollection 2014.
The 7th UICC N stage may be unsuitable for remnant gastric cancer (RGC) because the original disease and previous operation usually cause abnormal lymphatic drainage. However, the prognostic significance of the current TNM staging system in RGC has not been studied.
Prospective data from 153 RGC patients who underwent curative gastrectomy from Jan 1995 to Aug 2009 were reviewed. All patients were classified according to tumor size (<3 cm as N0;>3&≤5 cm as N1;>5&≤7 cm as N2; and>7 cm as N3). The overall survival was estimated using the Kaplan-Meier method, and hazard ratios (HRs) were calculated using the Cox proportional hazard model.
Tumor sizes ranged from 1.0 to 15.0 cm (median 5.0 cm). Tumor size, depth of invasion and lymph node (LN) metastasis were significant prognostic factors based on both the univariate and multivariate analyses (P<0.05). In the survival analysis, the seventh edition UICC-TNM classification provided a detailed classification; however, some subgroups of the UICC-TNM classification did not have significantly different survival rates. The combination of the seventh edition T classification and the suggested N classification, with ideal relative risk (RR) results and P value, was distinctive for subgrouping the survival rates except for the IA versus IB and II A versus IIB. A modified staging system based on tumor size, predicted survival more accurately than the conventional TNM staging system.
In RGCs, tumor size is an independent prognostic factor and a modified TNM system based on tumor size accurately predicts survival.
国际抗癌联盟（UICC）第7版N分期可能不适用于残胃癌（RGC），因为原发疾病和既往手术通常会导致淋巴引流异常。然而，目前的TNM分期系统在RGC中的预后意义尚未得到研究。
回顾了1995年1月至2009年8月期间153例行根治性胃切除术的RGC患者的前瞻性数据。所有患者根据肿瘤大小进行分类（<3 cm为N0；>3且≤5 cm为N1；>5且≤7 cm为N2；>7 cm为N3）。采用Kaplan-Meier法估计总生存率，并使用Cox比例风险模型计算风险比（HRs）。
肿瘤大小范围为1.0至15.0 cm（中位数5.0 cm）。基于单因素和多因素分析，肿瘤大小、浸润深度和淋巴结（LN）转移是显著的预后因素（P<0.05）。在生存分析中，UICC-TNM第7版分类提供了详细的分类；然而，UICC-TNM分类的一些亚组生存率没有显著差异。除IA与IB以及IIA与IIB外，UICC-TNM第7版T分类与建议的N分类相结合，具有理想的相对风险（RR）结果和P值，在亚组生存率分组方面具有独特性。基于肿瘤大小的改良分期系统比传统TNM分期系统更准确地预测生存率。
在RGC中，肿瘤大小是一个独立的预后因素，基于肿瘤大小的改良TNM系统能准确预测生存率。
