胃癌UICC第6与第7版TNM分期对预后预测的对比分析

Comparison of UICC staging between the sixth edition and seventh edition TNM classifications in gastric cancer

目的:探讨胃癌第7版UICC分期对判断预后的价值。方法:选择行胃癌根治术、临床病理及随访资料完整的360例胃癌患者为研究对象,按UICC第6版和第7版分别进行TNM分期,Kaplan-Meier生存曲线分析各期5年生存率。结果:360例患者的5年生存率为61.8%,中位生存时间为64.4个月(95%CI:60.6～68.2)。第7版Ⅰ、Ⅱ和Ⅲ期患者的5年生存率分别为95.4%、80.1%和37.4%;ⅡA和ⅡB期分别为81.9%和78.9%,ⅢA、ⅢB和ⅢC期分别为59.3%、46.1%和11.7%。与第6版比较,Ⅲ期各亚组间5年生存率差异有统计学意义,P=0.000。结论:第7版TNM分期更注重肿瘤局部浸润深度和淋巴结转移数目对胃癌预后的影响,所以分析预后更精确;同时分期的调整更符合临床实践的预后判断信息,量化复发风险,可指导不同亚期的患者进行个体化综合治疗。

OBJECTIVE： To evaluate the prognostic efficacy of the seventh edition tumor-node-metastasis （TNM） classification compared with the sixth edition in gastric cancer patients. METHODS： A total of 360 gastric cancer patients undergoing surgical resection who had complete clinical and pathological records were staged using the sixth and seventh edition staging systems. Survival curves were analyzed for the 5 year survival rate according to staging based on the TNM sixth and seventh editions. RESULTS： The overall 5-year survival rate of all patients were 61.8% and the median overall survival was 64.4 months （95%Ch 60.6--68.2）. The 5-year survival rate of stage Ⅰ , Ⅱ , Ⅲ according seventh edition were 95.4% ,80.1% and 37.4% respectively; 81.9% and 78.9% for the stage Ⅱ A and stage Ⅱ B respectively; 59.3%, 46.1% and 11.7 % for the Ⅲ A, Ⅲ B, Ⅲ C respectively. The difference between the subgroup of stage Ⅲ was more abvious in the seventh editions （P=0. 000）. CONCLUSIONS.. The TNM seventh edition pay more attention to tumor invasion depth and the number of metastastic lymph nodes which were associated with the prognosis. So, the adjustment of seventh edition has more accurate prognosis. We can use TNM seventh edition to quantify the risk of recurrence and guide the individualized therapy.