Gurzu Simona, Sugimura Haruhiko, Orlowska Janina, Szederjesi Janos, Szentirmay Zoltan, Bara Tivadar, Bara Tivadar, Fetyko Ananmaria, Jung Ioan
Department of Pathology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Department of Tumor Pathology, Hamamatsu University, Hamamatsu, Japan.
J Investig Med. 2017 Feb;65(2):316-322. doi: 10.1136/jim-2016-000270. Epub 2016 Sep 15.
The aim of this study was to present an epidemiological update regarding the classical prognostic parameters of gastric cancer (GC) in 3 countries from Eastern Europe and to suggest a modification of the pTNM staging system. In 333 consecutive cases which were diagnosed between 2003 and 2012 in 3 departments of pathology from Romania, Hungary, and Poland, the following parameters were analyzed: age and gender of patients, tumor localization, macroscopic and microscopic aspects including the degree of discohesivity, depth of tumor infiltration, and pTNM stage. From all of the studied parameters, the following proved to have independent prognostic value, indicating a lower survival rate: presence of distant metastases (p=0.001), lymph node positivity (p=0.0009), depth of tumor infiltration (p=0.04), age over 50 (p=0.02), proximally located tumors (p=0.03), and ulceroinfiltrative or diffusely infiltrative macroscopic aspect (p=0.0002). The pT2N1-3 staged cases showed a worse prognosis compared with the pT3N0 ones (p=0.02). Regardless of depth of invasion, the lymph node status remains the strongest indicator of the survival rate in GC. The pTN staging system should be adapted and a Dukes-MAC-like staging system should include the following groups: stage A1-T1N0, stage A2-T1N1-3, stage B1-T2N0, stage B2-T2N1-3, stage C1-T3N0, stage C2-T3N1-3, and stage D-T4N0-3. The grade of discohesivity/budding is not a prognostic factor in GC.
本研究旨在提供有关来自东欧3个国家胃癌（GC）经典预后参数的流行病学最新情况，并建议对pTNM分期系统进行修改。在罗马尼亚、匈牙利和波兰3个病理学部门于2003年至2012年间连续诊断的333例病例中，分析了以下参数：患者的年龄和性别、肿瘤定位、宏观和微观特征，包括解离度、肿瘤浸润深度和pTNM分期。在所有研究参数中，以下参数被证明具有独立的预后价值，表明生存率较低：远处转移的存在（p = 0.001）、淋巴结阳性（p = 0.0009）、肿瘤浸润深度（p = 0.04）、50岁以上（p = 0.02）、近端肿瘤（p = 0.03）以及溃疡浸润性或弥漫浸润性宏观特征（p = 0.0002）。与pT3N0病例相比，pT2N1 - 3分期的病例预后更差（p = 0.02）。无论浸润深度如何，淋巴结状态仍然是GC生存率的最强指标。pTN分期系统应进行调整，类似Dukes - MAC的分期系统应包括以下组：A1期 - T1N0，A2期 - T1N1 - 3，B1期 - T2N0，B2期 - T2N1 - 3，C1期 - T3N0，C2期 - T3N1 - 3，以及D期 - T4N0 - 3。解离度/出芽分级不是GC的预后因素。
