胃癌新TNM分期与其生物学行为及预后的关系

目的　分析胃癌新TNM分期的临床应用价值。　方法　对比分析 334例胃癌患者新、旧TNM分期中区域淋巴结转移 (pN)分级与患者预后及反映胃癌生物学行为的病理因素间的相关性。　结果　旧pN分级中pN1组术后 5年生存率为 49 6 % ,pN2 组为 33 5 % ,2组差异有显著性意义 (P <0 0 1) ;新pN分级中pN1组术后 5年生存率为 48 5 % ,pN2 组为 2 4 1% ,pN3 组为 5 6 %。 3组患者术后生存率差异有极显著意义 (P <0 0 1) ;新pN分级与患者胃癌的浸润深度、大体类型、浆膜分型和生长方式相关 (P <0 0 1) ;COX模型分析表明新pN分级是反映胃癌预后最主要的独立指标。　结论　与旧TNM分期相比 ,新TNM分期系统是估计胃癌预后更为合理的指标 ,并且较旧分期更简单、客观 ,具可重复性 ,易于推广应用。

Relationship between new TNM classification and the prognosis and biological behavior of gastric cancer

OBJECTIVE: To determine the clinical value of 1997 TNM classification of gastric cancer. METHODS: 334 cases of gastric cancer with regional lymph node metastasis were used to determine the relationship between new TNM classification and the prognosis and biological behavior compared with old classification (1987). RESULTS: The 5-year survival rates of the old pN(1), pN(2) were 49.6% and 33.5% respectively; those of the new pN(1), pN(2), pN(3) were 48.5%, 24.1% and 5.6% respectively. There was a highly significant difference in survival in different new pN groups (P < 0.01). The new pN classification was correlated with the depth of cancer invasion, as well as the macroscopic type, growth pattern and serosal type (P < 0.01). Multivariate COX model analysis showed that the new pN classification was the most significant independent prognostic factor. CONCLUSIONS: The new TNM classification is not only an objective, simple and reproducible system, but also a significant prognostic index for gastric cancer superior to the old classification.