胃癌TNM分期优化及病理质量控制

Optimization of TNM staging and control of pathological quality in gastric cancer

胃癌的综合治疗主要以病理分期(TNM)为依据。其中,T分期主要依靠对浸润胃壁深度的准确判定,准确T分期应做到规范化病理取材和必要的连续切片;N分期易受淋巴结捡取数影响,淋巴结捡取不足可导致N分期偏移。因此,规范淋巴结清扫及术后最大限度地捡取淋巴结是关键环节;M分期主要在于提高胃癌腹腔脱落癌细胞(CY1)阳性检出率,确定腹膜转移的高危因素,优化预测腹膜转移的分子标志物,作为临床检查的补充手段。现阶段我国胃癌规范化病理诊断的质量仍有待提升。本文结合国内外相关研究及本中心临床实践经验,就如何做好胃癌TNM分期的优化及病理质量控制等方面进行评述。

Comprehensive treatment of gastric cancer is mainly based on the pathological staging.The T stage mainly depends on the accurate determination of the depth of the tumor invasion.The accurate T stage should be standardized pathological examination and continuous sectioning.N stage may be influenced by the number of lymph node examined.Insufficient lymph node examined may lead to stage migration.Therefore,standardizing lymph node dissection and lymph node harvest after surgery is important.M stage is mainly to improve the detection rate of peritoneal lavage cytology(CY),identify high risk factors for peritoneal metastasis,and optimize the prediction of peritoneal metastasis molecular markers,as a complementary methods of clinical examination.Currently,the quality of standardized pathological diagnosis of gastric cancer in China still needs to be improved.This article mainly elucidates the related studies and clinical experience of our center on how to do better in the optimization of gastric cancer TNM staging and pathological quality control.