一种新的胃癌淋巴结分期方案

A new lymph-node staging system for gastric cancer

目的 比较AJCC/UICC 1997年第五版胃癌TNM分期中的N分期与以淋巴结转移度为标准的新N分期。 方法 行D2 或D3 术式的胃癌 (皆无远处转移 )标本用透光法摘取淋巴结 ,分别按 2种方法分期 ,新法中N1为淋巴结转移度 0 0 1%～ 10 0 0 %,N2 为 10 0 1%～ 2 5 0 0 %,N3 为 >2 5 0 0 %。全组随访 ,资料经统计学处理。 结果 本组 78例患者共取得淋巴结 5 388枚 ,平均每例6 9枚 (范围 30～ 15 7枚 )。全组淋巴结转移率 75 6 4%(5 9/ 78)。新分期N0 、N1、N2 、N3 期患者 3年生存率分别为 :10 0 %、6 8 4 2 %、7 5 8%、6 78%(χ2 =35 85 0 ,P <0 0 1,r=0 95 )。 结论 淋巴结转移度是一相对数 ,在预后的判断上 ,优于淋巴结转移数目。

Objective To evaluate the predictive effects of the new lymph node staging system based on the ratio of the number of metastatic lymph nodes to the total number of dissected lymphnodes comparing with N-staging of the 5th TNM (UICC,1997). Methods Lymph nodes harvested from operative speciemens in 78 patients with gastric cancer were examined histologically. pN staging was carried out according to the two staging systems respectively. In our system, pN 0,pN 1,pN 2,pN 3 were defined as lymph node ratio(LNR) 0,<10%,<25% and >25%, respectively. All the patients were followed up and the data were analyzed statistically. Results A total of 5?388 lymph nodes were found with a mean of 69 per case (range 30～157). Lymphnode metastases were detected in 59 patients (75.64%). The 3-year survival rates of pNo, pN 1, pN 2, pN 3 of the new staging system were 100%, 68.42%, 7.58% and 6.78%, respectively. Conclusion The lymph node ratio is a relative variable, which reflects the degree of metastasis of lymph node, and is more predictable than the UICC 1997 5th N-staging system defined as the numbers of metastatic lymph node.