一种原发性胃淋巴瘤的分期系统提议。

A proposed staging system for primary gastric lymphoma.

作者信息

Shimodaira M, Tsukamoto Y, Niwa Y, Goto H, Hase S, Hayakawa T, Nagasaka T

机构信息

Second Department of Internal Medicine, Nagoya University School of Medicine, Japan.

出版信息

Cancer. 1994 Jun 1;73(11):2709-15. doi: 10.1002/1097-0142(19940601)73:11<2709::aid-cncr2820731110>3.0.co;2-4.

DOI:10.1002/1097-0142(19940601)73:11<2709::aid-cncr2820731110>3.0.co;2-4

PMID:8194010

Abstract

BACKGROUND

Although primary gastric lymphoma is the most common extranodal lymphoma, no specific staging system exists.

METHODS

The authors reviewed 98 cases histologically classified according to the Working Formulation, including low grade B-cell lymphoma of mucosa-associated lymphoid tissue type. Survival rates were calculated by the Kaplan-Meier method according to T, N, and M of the general rules of the International Union Against Cancer TNM system. The definitions of these categories are as follows: T1, tumor invades the lamina propria or submucosa; T2, the muscularis propria; T3, the subserosa; T4, the serosa without invasion of adjacent structures; T5, adjacent structures; N0, no regional lymph node metastasis; N1, perigastric lymph nodes within 3 cm of the edge of the primary tumor; N2, perigastric lymph nodes more than 3 cm from the edge of the primary tumor or in lymph nodes along the left gastric, common hepatic, splenic, or celiac arteries; N3, paraaortic and hepatoduodenal lymph nodes and/or other intraabdominal lymph nodes; N4, beyond N3; M0, no distant metastasis; and M1, positive.

RESULTS

The overall 5-year survival rate was 83.5%; it was 100% in T1, 82.4% in T2, 84.2% in T3, 52.9% in T4, and 33.3% in T5; 93.9% in N0, 90.5% in N1, 66.2% in N2, and 44.4% in N3/N4; and 86.0% in M0 and 25.0% in M1. Based on these results, the authors proposed a new staging system as follows: Stage I, T1/N0, N1/M0; Stage II, T1/N2/M0, T2,T3/N0,N1,N2/M0; Stage III, T4,T5/any N/M0, any T/N3, N4/M0; and Stage IV, any T/any N/M1. According to this system, the 5-year survival rate significantly decreased as the stage progressed: 100% in Stage I, 88.9% in Stage II, 52.1% in Stage III, and 25.0% in Stage IV. In Stages I and II, survival rates were not significantly different whether chemotherapy was done or not, whereas in Stage III all patients treated with surgery alone died.

CONCLUSIONS

This staging system is useful for assessing prognosis of and deciding a therapeutic plan for primary gastric lymphoma.

摘要

背景

尽管原发性胃淋巴瘤是最常见的结外淋巴瘤，但尚无特定的分期系统。

方法

作者回顾了98例根据工作分类法进行组织学分类的病例，包括黏膜相关淋巴组织型低度B细胞淋巴瘤。根据国际抗癌联盟TNM系统的一般规则，按照T、N和M计算生存率。这些分类的定义如下：T1，肿瘤侵犯固有层或黏膜下层；T2，侵犯肌层；T3，侵犯浆膜下层；T4，侵犯浆膜但未侵犯相邻结构；T5，侵犯相邻结构；N0，无区域淋巴结转移；N1，距原发肿瘤边缘3cm以内的胃周淋巴结；N2，距原发肿瘤边缘超过3cm的胃周淋巴结或沿胃左、肝总、脾或腹腔动脉的淋巴结；N3，主动脉旁和肝十二指肠淋巴结和/或其他腹内淋巴结；N4，超过N3；M0，无远处转移；M1，有远处转移。

结果

总体5年生存率为83.5%；T1为100%，T2为82.4%，T3为84.2%，T4为52.9%，T5为33.3%；N0为93.9%，N1为90.5%，N2为66.2%，N3/N4为44.4%；M0为86.0%，M1为25.0%。基于这些结果，作者提出了一种新的分期系统如下：I期，T1/N0、N1/M0；II期，T1/N2/M0、T2、T3/N0、N1、N2/M0；III期，T4、T5/任何N/M0、任何T/N3、N4/M0；IV期，任何T/任何N/M1。根据该系统，5年生存率随着分期进展而显著降低：I期为100%，II期为88.9%，III期为52.1%，IV期为25.0%。在I期和II期，无论是否进行化疗，生存率无显著差异，而在III期，所有单纯接受手术治疗的患者均死亡。