癌结节的定义及其在胃癌诊疗中的临床意义

The defination of tumor deposit and its clinical significance in the diagnosis and treatment of gastric cancer

癌结节是胃癌中常见的组织病理学特征之一。随着外科淋巴结清扫和病理检测技术的提高,癌结节的检出数逐渐增多,其在胃癌分期、预后中的作用也逐渐受到重视。但由于缺少规范统一,不少国内外文献对癌结节的名称、定义和诊断标准仍有些混乱。因此,本文就癌结节的定义和诊断标准等做一文献综述,以期规范术语的使用,提高对癌结节的正确认识。癌结节是胃癌患者预后的独立危险因素之一。目前,国际抗癌联盟(UICC)、美国癌症联合会(AJCC)的分期系统及日本胃癌处理规约均建议将每个癌结节都当作一个转移的淋巴结被纳入N分期。但是此方法仅为经验性推荐,并无高等级循证医学证据支持。多项研究进行了将癌结节纳入TNM分期的探索,以期提高分期系统对预后判断的准确度和区分度。随着第8版TNM分期的广泛应用,如何将癌结节简单、合理地纳入新版TNM分期需要更多的探索。

Tumor deposit(TD)is a common histopathological finding in gastric cancer.With the improved ability of lymphadenectomy and pathological examination,the positive rate and harvested number of TD are also increasing.The role of TD in staging and prognosis prediction for gastric cancer patients is getting more attention.However,due to the lack of standardization and unification,the denomination,definition and diagnostic criteria are still controversial.The previous studies on the definition and diagnostic criteria of TD were reviewed to standardize the items and improve the awareness.TD is an independent prognostic factor in gastric cancer.Each TD should be counted separately as a lymph node in the final pN determination according to TNM staging system of the Union for International Cancer Control(UICC)or American Joint Committee on Cancer(AJCC)or Japanese classification of gastric carcinoma.But this rule is just an experience-based practice,without support from high-level evidence.Several studies have tried to incorporate TD into TNM staging system to improve the accuracy and discriminative ability.With the wide use of the 8th TNM staging system,how to incorporate TD into the new staging system in an easy and reasonable way still needs more investigations.