PTNM AND RESIDUAL TUMOR CLASSIFICATIONS PROBLEMS OF ASSESSMENT AND PROGNOSTIC-SIGNIFICANCE
PTNM AND RESIDUAL TUMOR CLASSIFICATIONS PROBLEMS OF ASSESSMENT AND PROGNOSTIC-SIGNIFICANCE
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DOI：
10.1007/bf00308624
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发表时间：
1995-03-01
影响因子：
2.6
通讯作者：
HERMANEK, P
中科院分区：
文献类型：
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作者：
HERMANEK, P
肿瘤的解剖学范围（TNM，pTNM）和治疗后的残留肿瘤状态（残留肿瘤或R分类）是胃肠癌患者结局的最强预测因子。pTNM和R分类的结果取决于所使用的方法。具体地，PN分类与检查的节点的数量相关。应指出骨髓中的微转移或孤立肿瘤细胞的发现，此类病例必须与其他转移病例分开分析。这同样适用于腹水或腹腔冲洗液细胞学阳性但未累及腹膜的患者。对于R分类，建议使用额外的描述符（conv）表示所使用的常规方法，（soph）表示复杂的方法，以表明分类所使用的方法。一般来说，只有在R 0切除（切除无残留肿瘤）后才能预期长期生存。食管癌R 0切除术后5年生存率为15%~ 40%，胃癌为40%~ 75%，结直肠癌为55%~ 60%; R1和R2切除术后5年生存率分别为5%左右。在R1和R2病例中，预后主要取决于有无远处转移，pT和pN的意义较小。在R 0切除后，有广泛的神经病变。仔细的pTNM分类可以很好地估计预后，并且可以被认为是任何治疗结果分析的金标准。
The anatomic extent of tumor (TNM, pTNM) and, in case of treatment, the residual tumor status following treatment (residual tumor, or R classification) are the strongest predictors for outcome of patients with gastrointestinal cancer. The results of the pTNM and the R classifications depend on the methods used. In particular, the pN classification correlates with the number of nodes examined. The findings of micrometastases or isolated tumor cells in bone marrow should be indicated, and such cases must be analyzed separately from other metastatic cases. The same applies to patients with positive cytology in ascites fluid or peritoneal washings without gross involvement of the peritoneum. For the R classification the additional descriptors (conv), for conventional methods used, and (soph), for sophisticated, are recommended to indicate the methods used for classification. In general, long-term survival can be expected only after R0 resection (resection without residual tumor). The observed 5-year survival after R0 resection is 15% to 40% for esophageal carcinoma, 40% to 75% for gastric carcinoma, and 55% to 60% for colorectal carcinoma; the respective figures for R1 and R2 resections are only about 5% each. In R1 and R2 cases prognosis is determined primarily by the absence or presence of distant metastases, and pT and pN are of minor significance. After R0 resection there is a wide spectrum of prognoses. Careful pTNM classification allows a good estimation of the prognosis and can be considered the gold standard for any analysis of treatment results.