Phillips R K, Hittinger R, Blesovsky L, Fry J S, Fielding L P
Br J Surg. 1984 Aug;71(8):604-10. doi: 10.1002/bjs.1800710813.
Modifications of Dukes' (1932) classification of rectal tumours have led to confusion. From the data of 2518 patients who had undergone curative colorectal surgery the interrelationships between tumour penetration, grade, vascular invasion and pattern of lymph node involvement have been examined and their individual relevance to survival determined. Subdivision of Dukes' A cases into those confined to the muscularis mucosae (A) and those penetrating into, but not through, the bowel wall (B1) should be abandoned. Despite interrelationships between lymph node status, grade of tumour and vascular invasion, they all contribute prognostic information independent of each other. Apical lymph node involvement, more than four lymph nodes involved and extensive primary tumours with nodal involvement all carry a bad prognosis. Although interrelated each variable is individually relevant. However, subgroups of patients with Dukes' C tumours have an observed survival significantly better than expected. When few lymph nodes are involved or the primary tumour is confined to the bowel wall but lymph nodes are involved, the expectation of life is equivalent to Dukes' B.
对杜克（1932年）直肠癌分类法的修改导致了混淆。从2518例接受结直肠癌根治性手术患者的数据中，研究了肿瘤浸润深度、分级、血管侵犯与淋巴结受累模式之间的相互关系，并确定了它们各自与生存率的相关性。应放弃将杜克A期病例细分为局限于黏膜肌层的病例（A期）和穿透但未穿过肠壁的病例（B1期）。尽管淋巴结状态、肿瘤分级和血管侵犯之间存在相互关系，但它们都各自独立地提供预后信息。顶端淋巴结受累、超过4个淋巴结受累以及伴有淋巴结受累的广泛原发性肿瘤均预后不良。虽然各变量相互关联，但每个变量都各自具有相关性。然而，杜克C期肿瘤患者亚组的实际生存率明显好于预期。当受累淋巴结较少或原发性肿瘤局限于肠壁但有淋巴结受累时，预期寿命与杜克B期相当。
