Classification of lymph node metastases from carcinoma of the stomach: Comparison of the old (1987) and new (1997) TNM systems
Classification of lymph node metastases from carcinoma of the stomach: Comparison of the old (1987) and new (1997) TNM systems
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DOI：
10.1007/pl00012365
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发表时间：
1999-07-01
影响因子：
2.6
通讯作者：
Cordiano, C
中科院分区：
文献类型：
--
作者：
de Manzoni, G;Verlato, G;Cordiano, C
目前对胃癌的PN分类是基于转移结节到原发灶的BE距离(TNM-1987)。国际抗癌联合会(UICC)最近提出了一种新的基于受累结节数目的分类系统(TNM-1997)。本前瞻性研究旨在验证这两种分类是否(1)为个体患者分配了大致相似的等级，(2)提供了可比较的预后信息。对1988年3月至1997年10月间175例胃癌根治性手术患者，在控制性别、年龄、部位、组织学和肿瘤侵袭深度的情况下，应用Cox回归模型评价阳性结节的距离或数目对预后的意义。在按TNM-1987分类为N1和N2的患者中，81.8%(36/44)和35.8%(19/53)的患者被新分类为N1和N2，两种分类的生存概率相似。TNM-1987的N2型也包括10例有15个阳性结节的病例(1997年的N3型)，他们表现出很大的超额死亡率(相对于N0的RR=35.14)。当阳性结节的部位和数目结合在一个新的变量中时，从预后的角度来看，两者似乎都很重要。解剖位置和转移结节数是影响胃癌患者生存的重要因素。当用新的分类替换旧的分类时应该谨慎，因为它们以不同的方式对患者进行分组。
The pN classification of gastric cancer is currently based on be distance of metastatic nodes from the primary tumor (TNM-1987). The UICC (Union Internationale Contre le Cancer) has recently proposed a new classification system based on the number of the involved nodes (TNM-1997). The present prospective study is aimed at verifying whether the two classifications (1) assign approximately a similar rank to individual patients and (2) give comparable prognostic information. The Cox regression model was used to evaluate the prognostic significance of either the distance or the number of positive nodes, controlling for sex, age, site, histology and depth of tumor invasion, in a group of 175 patients who underwent curative surgery for gastric cancer from March 1988 to October 1997. Among the patients classified as N1 and N2 according to TNM-1987, 81.8% (36/44) and 35.8% (19/53), respectively, were coded as N1 and N2 by the new classification, The survival probabilities of N1 and N2 categories were similar in both classifications. The N2 category of TNM-1987 comprised also 10 eases with >15 positive nodes (N3 category of TNM-1997), who presented a large excess mortality (RR = 35.14 with respect to N0). When the site and number of positive positive nodes are combined in a new variable, both appear to be important from a prognostic point of view. Both anatomic location and number of nodes with metastasis are important predictors of survival in gastric cancer patients. Caution should be used when replacing the old classification with the new one, as they group patients in a different way.