Raraty M G, Winstanley J H
Department of Surgery, Royal Liverpool University Hospital.
Ann R Coll Surg Engl. 1998 May;80(3):188-91.
Dukes' staging is the most common means of staging and grouping colorectal carcinomas and is also used to determine which patients will be offered adjuvant therapies or entered into clinical trials. This study was performed to assess the degree of variation in the staging of colorectal carcinomas in normal clinical practice. Seven consultant surgeons and two consultant pathologists returned questionnaires asking them to stage 14 carcinomas on the basis of their pathology reports alone. The results show agreement among all nine in only six out of the 14 cases. In two cases there was a close to 50:50 split in perceived stage. Between them, the nine consultants produced eight different sets of staging results. These results indicate difficulties in the application of Dukes' staging system for several possible reasons. There may be misinterpretation of the written report, misapplication of the staging system because of unfamiliarity or confusion between the various modifications of Dukes' system which have been published. A more precisely defined staging system based on a standard proforma may be more appropriate in modern clinical practice.
杜克斯分期是对结直肠癌进行分期和分组的最常用方法，也用于确定哪些患者将接受辅助治疗或参与临床试验。本研究旨在评估在正常临床实践中结直肠癌分期的变异程度。七位外科顾问医生和两位病理顾问医生回复了问卷，要求他们仅根据病理报告对14例癌症进行分期。结果显示，在14例病例中，所有9位医生仅在6例上达成了一致。在2例病例中，对分期的判断几乎是50:50的分歧。这9位顾问医生之间产生了8套不同的分期结果。这些结果表明，由于多种可能的原因，杜克斯分期系统在应用中存在困难。可能存在对书面报告的误解，由于不熟悉或混淆已发表的杜克斯系统的各种修改版本而导致分期系统应用不当。在现代临床实践中，基于标准格式更精确界定的分期系统可能更合适。
