Shimada Hideaki, Fukagawa Takeo, Haga Yoshio, Okazumi Shin-Ichi, Oba Koji
Department of Gastroenterological Surgery Toho University Graduate School of Medicine Tokyo Japan.
Department of Surgery Teikyo University School of Medicine Tokyo Japan.
Ann Gastroenterol Surg. 2021 Feb 18;5(4):404-418. doi: 10.1002/ags3.12444. eCollection 2021 Jul.
Clinical staging is vital for selecting appropriate candidates and designing neoadjuvant treatment strategies for advanced tumors. The aim of this review was to evaluate diagnostic abilities of clinical TNM staging for gastrointestinal, gastrointestinal cancers.
We conducted a systematic review of recent publications to evaluate the accuracy of diagnostic modalities on gastrointestinal cancers. A systematic literature search was performed in PubMed/MEDLINE using the keywords "TNM staging," "T4 staging," "distant metastases," "esophageal cancer," "gastric cancer," and "colorectal cancer," and the search terms used in Cochrane Reviews between January 2005 to July 2020. Articles focusing on preoperative diagnosis of: (a) depth of invasion; (b) lymph node metastases; and (c) distant metastases were selected.
After a full-text search, a final set of 55 studies (17 esophageal cancer studies, 26 gastric cancer studies, and 12 colorectal cancer studies) were used to evaluate the accuracy of clinical TNM staging. Positron emission tomography-computed tomography (PET-CT) and/or magnetic resonance imaging (MRI) were the best modalities to assess distant metastases. Fat and fiber mode of CT may be useful for T4 staging of esophageal cancer, CT was a partially reliable modality for lymph node staging in gastric cancer, and CT combined with MRI was the most reliable modality for liver metastases from colorectal cancer.
The most reliable diagnostic modality differed among gastrointestinal cancers depending on the type of cancer. Therefore, we propose diagnostic algorithms for clinical staging for each type of cancer.
临床分期对于为晚期肿瘤选择合适的候选患者及设计新辅助治疗策略至关重要。本综述的目的是评估临床TNM分期对胃肠道癌的诊断能力。
我们对近期发表的文献进行了系统综述，以评估胃肠道癌诊断方法的准确性。在PubMed/MEDLINE中使用关键词“TNM分期”“T4分期”“远处转移”“食管癌”“胃癌”和“结直肠癌”进行系统文献检索，并检索了2005年1月至2020年7月期间Cochrane综述中使用的检索词。选择关注以下方面术前诊断的文章：（a）浸润深度；（b）淋巴结转移；（c）远处转移。
经过全文检索，最终纳入55项研究（17项食管癌研究、26项胃癌研究和12项结直肠癌研究）来评估临床TNM分期的准确性。正电子发射断层扫描-计算机断层扫描（PET-CT）和/或磁共振成像（MRI）是评估远处转移的最佳方法。CT的脂肪和纤维模式可能有助于食管癌的T4分期，CT是胃癌淋巴结分期的部分可靠方法，CT联合MRI是结直肠癌肝转移最可靠的方法。
不同类型的胃肠道癌中最可靠的诊断方法有所不同。因此，我们提出了每种癌症临床分期的诊断算法。
