Martin I G, Dixon M F, Sue-Ling H, Axon A T, Johnston D
Academic Department of Surgery, General Infirmary at Leeds.
Gut. 1994 Jun;35(6):758-63. doi: 10.1136/gut.35.6.758.
TNM (tumour, node, metastases) staging has thus far been the most important guide to prognosis in patients with gastric cancer. Histological grading, in contrast, has not provided any additional information. Recently a novel grading system based on tubular differentiation and mucus production has been proposed, which was correlated with patterns of tumour spread found at necropsy. This study set out to assess its value as a determinant of survival after gastric resection. In a consecutive series of 211 patients who had potentially curative resection for gastric cancer, five histological grading systems were assessed: the Lauren type, the WHO type, degree of differentiation, the type of tumour border, and the lymphocytic response to the tumour and compared with the Goseki grading (I-IV). When T and N stage were taken into account, using Cox's proportional hazards model, only the Goseki grading added further to the ability to predict survival. The proportional hazards ratios were: node negative v node positive 6.5 T1 v T3 2.45; Goseki I v Goseki IV 3.1. Five year survival of patients with mucus rich (Goseki II and IV) T3 tumours was significantly worse than that of patients with mucus poor (Goseki I and III) T3 tumours (18% v 53%, p < 0.003). Goseki grading identifies subgroups of patients with a poorer prognosis than is predicted by TNM staging alone. It could prove useful in the selection of patients for adjuvant therapy after potentially curative resection for gastric cancer.
TNM（肿瘤、淋巴结、转移）分期一直是胃癌患者预后的最重要指导。相比之下，组织学分级并未提供任何额外信息。最近有人提出了一种基于管状分化和黏液产生的新分级系统，该系统与尸检时发现的肿瘤扩散模式相关。本研究旨在评估其作为胃癌切除术后生存决定因素的价值。在连续的211例接受了胃癌根治性切除术的患者中，评估了五种组织学分级系统：劳伦分型、世界卫生组织分型、分化程度、肿瘤边界类型以及对肿瘤的淋巴细胞反应，并与戈塞基分级（I-IV级）进行比较。在考虑T和N分期的情况下，使用考克斯比例风险模型，只有戈塞基分级在预测生存能力方面有进一步提高。比例风险比为：淋巴结阴性对淋巴结阳性6.5；T1对T3 2.45；戈塞基I级对戈塞基IV级3.1。黏液丰富（戈塞基II级和IV级）的T3肿瘤患者的五年生存率明显低于黏液缺乏（戈塞基I级和III级）的T3肿瘤患者（18%对53%，p<0.003）。戈塞基分级识别出了预后比仅由TNM分期预测的更差的患者亚组。它可能在为胃癌根治性切除术后的辅助治疗选择患者方面证明是有用的。
