基于T4评分的胃癌肿瘤深度预测

Tumor Depth Prediction of Gastric Cancer With a T4 Score.

作者信息

Taniguchi Kiyoaki, Ota Masaho, Yamada Takuji, Serizawa Akiko, Kotake Sho, Ito Shunichi, Suzuki Kazuomi, Yamamoto Masalazu

机构信息

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.

出版信息

Cancer Diagn Progn. 2022 Nov 3;2(6):641-647. doi: 10.21873/cdp.10154. eCollection 2022 Nov-Dec.

DOI:10.21873/cdp.10154

PMID:36340460

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9628156/

Abstract

BACKGROUND/AIM: Peritoneal metastases are often found at surgery of pT4 gastric cancers, preventing R0 resection. In the event of successful R0 resection, distant metastases still occur in a sizeable proportion of patients. Estimation of the depth of invasion has a relatively low accuracy (57%-86%) compared with pathological findings. This study sought to develop a clinical score to distinguish between pathological stage T4 (pT4) and pT1-3 gastric cancer.

PATIENTS AND METHODS

Reviewing the data of 2,771 patients who had undergone gastrectomy at our hospital from January 1996-December 2016, we assessed demographic factors plus tumor markers, diameter, location, histology, and macroscopic type according to the fifth edition (2019) of the WHO classification. Significant factors on multivariate analysis were used to develop a pT4 gastric cancer depth prediction score (T4 score).

RESULTS

Multivariate analysis revealed that the clinical factors associated with pT4 disease were CA19-9 elevation, tumor diameter ≥50 mm, poorly cohesive type adenocarcinoma, mucinous adenocarcinoma, and WHO macroscopic types 2-4. The T4 score was obtained by weighing these factors according to the β-coefficient. The optimum cutoff value of the T4 score was 4 points. A total of 79.4% of cases with a T4 score ≥4 points were stage pT4. A total of 93.9% of cases with a T4 score <4 points were stage pT1-3, with 91.1% sensitivity, 85.3% specificity, 79.4% positive predictive value, and 93.9% negative predictive value.

CONCLUSION

T4 scoring can differentiate pT4 gastric cancer from pT1-3 gastric cancer.

摘要

背景/目的：腹膜转移在pT4期胃癌手术中经常被发现，这会妨碍R0切除。即使成功进行了R0切除，仍有相当一部分患者会发生远处转移。与病理结果相比，浸润深度的估计准确性相对较低（57%-86%）。本研究旨在开发一种临床评分系统，以区分病理分期为T4（pT4）和pT1-3期的胃癌。

患者与方法

回顾1996年1月至2016年12月在我院接受胃切除术的2771例患者的数据，我们根据世界卫生组织（WHO）第五版（2019年）分类评估了人口统计学因素以及肿瘤标志物、直径、位置、组织学和大体类型。多因素分析中的显著因素被用于开发pT4期胃癌深度预测评分（T4评分）。

结果

多因素分析显示，与pT4疾病相关的临床因素包括CA19-9升高、肿瘤直径≥50mm、低黏附性腺癌、黏液腺癌以及WHO大体类型2-4。通过根据β系数对这些因素进行加权得出T4评分。T4评分的最佳临界值为4分。T4评分≥4分的病例中，共有79.4%为pT4期。T4评分<4分的病例中，共有93.9%为pT1-3期，敏感性为91.1%，特异性为85.3%，阳性预测值为79.4%，阴性预测值为93.9%。