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[进展期胃癌组织学分类的预后价值:劳伦分类法与五木分类法的比较研究]

[Prognostic value of histologic classifications of advanced stomach cancer: comparative study of Lauren's and Goseki's classifications].

作者信息

Guglielmi A, de Manzoni G, Tomezzoli A, Ricci F, Pelosi G, Laterza E, Di Leo A, Bonfiglio M

机构信息

Istituto di Semeiotica Chirurgica, Università degli Studi, Verona.

出版信息

Chir Ital. 1997;49(3):45-9.

PMID:9612652
Abstract

Controversy exists about the prognostic value of the histological classifications of gastric cancer commonly used. Recently Goseki proposed a new classifying system based on intracellular mucus production and the degree of tubular differentiation. The aim of this study was to compare Lauren and Goseki classifications with particular emphasis on their prognostic significance. Eighty-nine patients, who underwent potentially curative resections (RO) and radical lymphadenectomy for advanced gastric cancer from September 1988 to April 1996 were analysed. Cox regression model was used to evaluate the prognostic significance of Goseki classification, Lauren classification, age, sex, type of lymphadenectomy, depth of tumour invasion (T), node metastases (N) and number of metastatic nodes. A statistically significant correlation between the different Goseki grades and histology according to Lauren was found (p < 0.001). By multivariate analysis the only parameters predictive of long term outcome were depth of tumour invasion, nodal status and histology according to the Lauren classification. Also after excluding the Lauren classification from the analysis, the Goseki histological grading system did not affect survival independently. This study on advanced gastric cancer patients identified depth of invasion, lymph node metastases and Lauren classification as significant independent pathological variables influencing survival. The classification proposed by Goseki did not add anything further to the prognostic informations provided by TNM staging and Lauren classification.

摘要

关于常用的胃癌组织学分类的预后价值存在争议。最近,五关提出了一种基于细胞内黏液产生和管状分化程度的新分类系统。本研究的目的是比较劳伦分类法和五关分类法,特别强调它们的预后意义。分析了1988年9月至1996年4月期间接受了晚期胃癌根治性切除(RO)和根治性淋巴结清扫术的89例患者。采用Cox回归模型评估五关分类法、劳伦分类法、年龄、性别、淋巴结清扫类型、肿瘤浸润深度(T)、淋巴结转移(N)和转移淋巴结数量的预后意义。发现五关不同分级与劳伦分类法的组织学之间存在统计学显著相关性(p < 0.001)。多因素分析显示,唯一能预测长期预后的参数是肿瘤浸润深度、淋巴结状态和劳伦分类法的组织学。在分析中排除劳伦分类法后,五关组织学分级系统也不能独立影响生存。这项对晚期胃癌患者的研究确定了浸润深度、淋巴结转移和劳伦分类法是影响生存的重要独立病理变量。五关提出的分类法并未为TNM分期和劳伦分类法提供的预后信息增添更多内容。

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