胃癌患者临床与病理TNM分期一致性分析

Analysis of consistency between clinical and pathological TNM stag- ing for gastric cancer

目的探讨胃癌患者术前临床TNM分期与术后病理TNM分期的一致性并分析其原因。方法选取甘肃省人民医院普外二科2010年12月-2011年12月手术治疗的胃癌患者临床资料完整者64例，参照日本胃癌学会（JGCA）（2010年第14版）拟定的胃癌TNM分期标准，对所有患者进行术后病理分期，并与术前临床分期进行对比。应用统计软件SPSS18．0分析T、N、M分期统计量的一致性。结果术前临床T分期与术后病理T分期的Kappa值为0．729，两者一致性较好；N分期的Kappa值为0．216，一致性较差；M分期的Kappa值为0．743，两者一致性较好。结论新版《胃癌处理规约》应用临床后，可以较为准确的判断TNM分期，有利于指导个体化的治疗方案，但仍存在高估或者低估的情况，尤其是N分期的差异性较大，因此，术前综合各种资料，正确判断N分期是提高术前临床TNM分期准确率，制定治疗方案的关键。

Objective To explore the consistency between preoperative clinical TNM stage and postoperative pathological TNM stage of gastric cancer and look for the underlying reason. Methods Sixty-four patients of gastric cancer with complete clinical data from December 2010 to December 2011 in Gansu Provincial Hospital were enrolled into this study. All cases were performed postoperative pathological TNM staging according to the TNM stage criteria of gastric eancer from JGCA （the 14th edition, 2010）, and the results were compared with preoperative TNM staging, then we studied the consistency of T staging, N staging and M staging using SPSS 18.0. Results The Kappa value from T staging of preoperative and postoperative was 0. 729, showing a good consistency. The N stage＇ s consistency was lower, Kappa value being only 0. 216. For M staging, Kappa value 0. 743, having a good consistency. Conclusions According to the General Rules for Gastric Cancer Treatment, a accurate TNM staging and individual treatment plan can be made for gastric cancer patients in clinic. But the overestimate and underestimate still existed, especially in N staging. Therefore, making a accurate judgment for N staging according to all kinds of preoperative clinical data and images is the key to improvement of preoperative TNM staging accuracy and treatment.