不同TNM分期标准在胃癌患者预后评估中的价值

摘要

背景:胃癌合理分期对选择患者的治疗方案、判断疗效以及预后评估等均具有重要的指导意义.目的:探讨第6版和第7版胃癌TNM分期标准在胃癌患者预后评估中的价值.方法:收集955例有完整临床病理和随访资料的胃癌病例,应用第6版和第7版TNM分期标准分别对其预后进行评估,以Kaplan-Meier生存分析比较这两种标准对胃癌患者预后的评估价值.结果:按第6版TNM分期标准,Ⅰ期209例(21.9％)、Ⅱ期147例(15.4％)、Ⅲ期300例(31.4％)和Ⅳ期299例(31.3％)；按第7版分期标准,Ⅰ期168例(17.6％)、Ⅱ期170例(17.8％)、Ⅲ期569例(59.6％)和Ⅳ期48例(5.0％).两种分期的Ⅲ、Ⅳ期患者的生存时间均显著低于Ⅰ、Ⅱ期(P＜0.05).第6版ⅢA期患者在第7版中分为ⅢA期和ⅢB期,两者之间生存时间相比差异有统计学意义(P＜0.05)；第6版Ⅳ期患者在第7版中分为ⅢB、Ⅲc、Ⅳ期,这三组的生存时间相比差异有统计学意义(P＜0.05).在第7版分期中,肿瘤侵及邻近结构(T4B)患者的生存时间较穿透浆膜层(T4A)的患者明显缩短(P＜0.05)；N1期和N2期患者生存时间相比差异有统计学意义(P＜0.05).结论:第6版TNM分期标准相对简易,对胃癌患者预后评估有一定价值；第7版TNM分期标准进一步细分,更能精确判别胃癌的生物学行为,对晚期胃癌患者的准确判断以及术后辅助治疗具有重要指导作用.%Reasonable staging of gastric cancer is very important for selecting therapy, evaluating rrnefficacy and predicting prognosis in patients with gastric cancer. Aims: To compare the rrnvalue for predicting prognosis between the 6' and 7th editions of TNM staging system in rrngastric cancer patients. Methods: A total of 955 gastric cancer patients with complete rrnclinicopathological and follow-up data were staged by the 6th and 7th editions of TNM rrnstaging system. Value for predicting prognosis by these two systems was compared by Kaplan-rrnMeier' s survⅣal analysis. Results: Evaluated by the 6th edition system, 209 cases (21.9%) rrnwere classified as stage I , 147 cases (15.4%) as stage H , 300 cases (31.4%) as stage Ⅲ rrnand 299 cases (31.3%) as stage Ⅳ. By the 7th edition system, 168 cases (17.6%) were rrnclassified as stage Ⅰ , 170 cases (17. 8% ) as stageⅡ, 569 cases (59. 6% ) as stage Ⅲ and rrn48 cases (5.0%) as stage Ⅳ. In both two systems, the survⅣal time of stages Ⅲ, Ⅳ rrnpatients was shorter than those of stages Ⅰ, Ⅱ(P < 0. 05 ). Patients with stage ⅢA by the rrn6th edition system were classified as stages ⅢA,ⅢB by the 7th edition system, and rrnsignificant difference in survⅣal time was found between the two substages ( P < 0. 05 ). rrnPatients with stage Ⅳ by the 6' edition system were classified as stages ⅢB,ⅢC Ⅳ by the rrn7th edition system, and significant difference in survⅣal time was found among the three rrnsubstages (P<0. 05). The survⅣal time of patients whose tumor invaded adjacent tissue (T4B) rrnwas shorter than those with tumor penetrating the serosa (T4A) (P <0. 05). There was rrnsignificant difference in survⅣal time between N1 and N2 classified by the 7th edition rrnsystem (P < 0. 05). Conclusions: The 6th edition system is relatively simple, and has some rrnvalue for predicting prognosis of gastric cancer, while the 7th edition system shows better rrnperformance in evaluating biological behavior of gastric cancer, and plays a guide role in rrnthe accurate estimation of advanced gastric cancer and use of adjunctⅣe therapy after rrnsurgery.