Goffinet D R, Warnke R, Dunnick N R, Castellino R, Glatstein E, Nelsen T S, Dorfman R F, Rosenberg S A, Kaplan H S
Cancer Treat Rep. 1977 Sep;61(6):981-92.
A consecutive unselected series of 423 patients with non-Hodgkin's lymphomas was staged prospectively at the Stanford Medical Center between June 1971 and June 1976. The histopathologic classification of Rappaport was used exclusively. Staging laparotomies were performed in 197 of the patients, but another 226 patients were excluded from the staging procedure for a variety of reasons, including stage IV involvement, poor surgical risk, and diagnostic celiotomy before referral to Stanford. Gastrointestinal, splenic, bone marrow, hepatic, and mesenteric lymph node involvement was very common in these patients, whereas systemic symptoms and mediastinal sites of disease were less frequently noted. After staging laparotomy, 15 patients (8%) were downstaged to a lesser extent of involvement while 62 (31%) were upstaged, primarily from clinical stage III to pathologic stage IV. Correlations were made between clinical and pathologic staging and the sites of involvement were compared between those with nodular and those with diffuse lymphomas. The accuracy of diagnostic radiologic procedures was also assessed. Although it is valuable in sequentially determining the extent of subdiaphragmatic involvement by lymphomas, we believe that staging laparotomy should still be regarded as a research procedure which will be undertaken only as indicated in centers of clinical research.
1971年6月至1976年6月期间，斯坦福医学中心对423例非霍奇金淋巴瘤患者进行了前瞻性分期，这些患者是连续入选且未经过筛选的。所有病例均采用拉帕波特组织病理学分类法。197例患者接受了分期剖腹探查术，但另有226例患者因各种原因被排除在分期程序之外，这些原因包括IV期受累、手术风险高以及在转诊至斯坦福之前进行了诊断性剖腹术。这些患者中胃肠道、脾脏、骨髓、肝脏和肠系膜淋巴结受累非常常见，而全身症状和纵隔病变部位则较少见。分期剖腹探查术后，15例患者（8%）分期降低至受累程度较轻，而62例患者（31%）分期升高，主要是从临床III期升至病理IV期。对临床分期和病理分期进行了相关性分析，并比较了结节性淋巴瘤和弥漫性淋巴瘤患者的受累部位。还评估了诊断性放射学检查的准确性。尽管它在依次确定淋巴瘤膈下受累程度方面很有价值，但我们认为分期剖腹探查术仍应被视为一种研究性操作，仅在临床研究中心有指征时才进行。
