Huang Jin-Yu, Wang Zhen-Ning, Lu Chun-Yang, Miao Zhi-Feng, Zhu Zhi, Song Yong-Xi, Xu Hui-Mian, Xu Ying-Ying
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.
J Surg Res. 2016 Jun 15;203(2):258-67. doi: 10.1016/j.jss.2016.04.026. Epub 2016 Apr 23.
The impact of macroscopic pathologic features of primary tumor that could be obtained preoperatively on pT classification has not been reported so far. The aim of this study was to investigate the feasibility of incorporation of Borrmann type IV gastric cancer into the pT classification.
Clinicopathologic and prognostic data of 1622 patients with advanced gastric cancer who underwent radical surgery were retrospectively studied.
Of 1622 patients, 135 (8.32%) patients were classified as having Borrmann type IV gastric cancer. We first confirmed that Borrmann type IV gastric cancer was one of the independent prognostic factors for patients with advanced gastric cancer who underwent radical surgery. Interestingly, we found that overall survival of patients with Borrmann type IV gastric cancer could be clearly distinguished by pN classification and pathological TNM stage but not by pT classification. Importantly, further analysis demonstrated that the prognosis of Borrmann type IV gastric cancers was homogeneous with that of pT4b cancers but poorer than pT2, pT3, pT4a cancers. Therefore, we proposed a novel pT classification in which pT4b disease was defined as cancers that were Borrmann type IV or those that had invaded adjacent structures. Two-step multivariate analysis demonstrated that the novel pT classification was more suitable for prognostic assessment than the original classification.
Classifying Borrmann type IV gastric cancer as pT4b disease improves pT classification prediction of prognosis in patients with advanced gastric cancer after radical surgery.
目前尚未见术前可获得的原发性肿瘤宏观病理特征对pT分类影响的报道。本研究旨在探讨将Borrmann Ⅳ型胃癌纳入pT分类的可行性。
回顾性研究1622例行根治性手术的进展期胃癌患者的临床病理及预后资料。
1622例患者中，135例（8.32%）被分类为Borrmann Ⅳ型胃癌。我们首先证实Borrmann Ⅳ型胃癌是行根治性手术的进展期胃癌患者的独立预后因素之一。有趣的是，我们发现Borrmann Ⅳ型胃癌患者的总生存期可通过pN分类和病理TNM分期明确区分，但不能通过pT分类区分。重要的是，进一步分析表明Borrmann Ⅳ型胃癌的预后与pT4b癌的预后相似，但比pT2、pT3、pT4a癌差。因此，我们提出了一种新的pT分类，其中pT4b疾病定义为Borrmann Ⅳ型癌或侵犯相邻结构的癌。两步多因素分析表明，新的pT分类比原分类更适合预后评估。
将Borrmann Ⅳ型胃癌分类为pT4b疾病可改善根治性手术后进展期胃癌患者pT分类对预后的预测。
