组织学类型对胃癌患者术前 N 分期准确性的影响。
The impact of histological type on the accuracy of preoperative N staging in patients with gastric cancer.
机构信息
First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
出版信息
World J Surg Oncol. 2019 Aug 1;17(1):130. doi: 10.1186/s12957-019-1674-9.
BACKGROUND
The low accuracy of preoperative diagnosis of lymph node metastasis in gastric cancer (GC) complicates decisions on patient indication for neoadjuvant chemotherapy.
METHODS
We investigated the use of preoperative clinical diagnosis of lymph node involvement (cN) in GC patients compared with postoperative pathological diagnosis.
RESULTS
In a series of 265 patients enrolled at the University of Yamanashi Hospital, the overall sensitivity was 44.4% and specificity was 93.4% of CT for detecting lymph node metastasis. The positive and negative predictive values were 80.0% and 73.8%, respectively. The negative predictive value was lower for undifferentiated adenocarcinoma than that for differentiated adenocarcinoma (64.9% vs. 78.7%, p = 0.034). In cT2 ≤ and cN2 ≤ GC, overdiagnosis of lymph node metastasis was significantly more frequent in patients with differentiated (50.0%) than in undifferentiated (13.3%) adenocarcinoma (p = 0.046).
CONCLUSIONS
Diagnostic accuracy of lymph node involvement depended on histological type and cT-stage. Thus, considering preoperative histological type in GC, it may be useful to decide treatment plan.
背景
胃癌（GC）术前淋巴结转移诊断准确性低，这使得患者是否接受新辅助化疗的适应证决策变得复杂。
方法
我们研究了术前临床诊断（cN）与术后病理诊断在 GC 患者中对淋巴结受累的诊断准确性。
结果
在山梨大学医院的 265 例患者系列中，CT 对检测淋巴结转移的总体敏感性为 44.4%，特异性为 93.4%。阳性和阴性预测值分别为 80.0%和 73.8%。未分化腺癌的阴性预测值低于分化腺癌（64.9%比 78.7%，p=0.034）。在 cT2≤和 cN2≤GC 中，分化型（50.0%）腺癌比未分化型（13.3%）腺癌更容易过度诊断淋巴结转移（p=0.046）。
结论
淋巴结受累的诊断准确性取决于组织学类型和 cT 分期。因此，考虑 GC 的术前组织学类型，可能有助于决定治疗计划。
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