国际抗癌联盟和日本胃癌协会胃癌淋巴结分期法与国人胃癌患者预后相关性的比较

目的 比较国际抗癌联盟(UICC)和日本胃癌协会(JGCA)两种胃癌淋巴结分期法与胃癌预后的相关性,评价其在胃癌预后评估中的指导意义和应用价值.方法 1996年1月至2005年12月间,经D2及以上胃癌根治手术,清扫淋巴结数目≥15枚,并有完整随访资料的395例胃癌患者为研究对象,分别以两种淋巴结分期法进行分期并绘制生存曲线.以Kaplan-Meier法进行生存率分析,Log rank检验评估组间的差异.结果 按UICC法分期后,各组间患者的生存率差异更明显.对T3期患者分别以两种方法分组并进行生存率比较显示,按照UICC法分期各组间的差异更明显.对两种分期后的N亚期以另一种标准相互再分期后,生存曲线显示,以UICC法对JGCA法分期后的各组再分期所产生的差异比以JGCA法对UICC法分期后的各组再分期后所产生的差异明显.在JGCA分期标准中,Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb和Ⅳ期患者的5年生存率分别为100.0%、96.9%、79.3%、54.2%、16.8%和11.2%;在UICC TNM分期标准中,其5年生存率分别为100.0%、96.9%、75.4%、51.8%、18.4%和10.5%.各期患者的5年生存率差异均无统计学意义(P>0.05).结论 UICC TNM胃癌分期标准与预后的相关性更好,对胃癌患者的预后评估和治疗方案的制定有更为客观的指导意义;而施行标准的D2胃癌根治手术和清扫至少15枚淋巴结是实行UICC分期法所必需的.

Comparison of the prognostic value of UICC and JGCA lymph node staging criteria for gastric cancer

Objective To compare the correlation of prognosis with UICC or JGCA lymph node staging criteria for gastric cancer and evaluate the value of application of those two TNM staging systems in prognosis prediction. Methods From January 1996 to December 2005, 395 gastric cancer patients who underwent D2 or D2 plus radical gastrectomy with ≥15 lymph nodes removed were enrolled into this study. The data were analyzed by both UICC and JGCA lymph node staging criteria, respectively. Kaplan-Meier method was applied to analyze the survival rates, and Log-rank test was performed to assess the statistical significance among groups. Results Compared with the survival curve based on JGCA lymph node staging criteria, UICC lymph node staging system showed a much more significant difference among N subgroups, and similar result was also found in the patients with T3 disease. The N subgroups stratified by UICC criteria were re-staged with JGCA, while the N subgroups by JGCA criteria with UICC. Though the difference among subgroups were not statistically significant in either group, it was greater based on UICC criteria than that based on JGCA. No significant difference was found in the 5-year survival rates of stageⅠ, Ⅱ, Ⅲ and Ⅳ based on either UICC or JGCA TNM staging criteria. Conclusion Our results show that UICC staging system is more predictive and relevant to prognosis than JGCA staging system for gastric cancer, and D2 or D2 plus radical gastrectomy with at least or more than 15 lymph nodes removed is required when UICC-TNM gastric cancer staging criteria is applied.