PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow
PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow
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DOI：
10.1007/s10147-007-0755-x
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发表时间：
2008-08-01
影响因子：
3.3
通讯作者：
Yoh, Zen
中科院分区：
文献类型：
--
作者：
Kinami, Shinichi;Fujimura, Takashi;Yoh, Zen
背景。我们提出了一种新的胃癌位置分类- PTD分类（即P区，T区和D区，见下文），根据生理淋巴流动进行分类。在我院行前哨淋巴结定位的T1或小T2胃癌患者共336例。研究了前哨淋巴结的定位与生理淋巴流量的关系。淋巴池被定义为由染色的淋巴管流划分的淋巴区。146例患者行标准胃切除术，切除D2以上，其余190例患者行保功能胃切除术，不切除淋巴盆外淋巴结。前一组观察淋巴结转移的进展规律；淋巴结转移首先发生在前哨淋巴结，很少延伸到淋巴盆外。在后一组中，没有患者复发。我们提出的PTD分类如下：近端区（P区）与过渡区（T区）的分界线是左胃网膜动脉与右胃网膜动脉的分水岭点与左胃动脉第一降支流入点的连接线；T区与远端区（D区）的分界线为距幽门8厘米半径的圆弧。位于胃右动脉区t区肿瘤未见淋巴池。PTD分类的优势在于，如果将PTD分类作为胃切除手术的指导，保留幽门将成为可能，而不会降低位于T区的cT1N0癌患者的预后。
Background. We propose a new classification for the location of gastric cancer - the PTD classification (i.e., zones P, T, and D; see below), with the zones classified according to the physiological lymphatic flow.Methods. Three hundred and thirty-six patients with T1 or small T2 gastric cancer who underwent sentinel node mapping at our hospital were enrolled. The relationship between the location of the gastric cancer and the physiological lymphatic flow derived from sentinel node mapping was investigated. Lymphatic basins were defined as lymphatic zones divided by the stream of stained lymphatic canals.Results. One hundred and forty-six patients underwent standard gastrectomy with more than D2 dissection and the other 190 patients underwent function-preserving gastrectomy with the omission of lymph node dissection outside the lymphatic basin. In the former group, the progression pattern of lymph node metastasis was observed; nodal metastasis occurred in sentinel nodes first, and rarely extended outside the lymphatic basin. In the latter group, none of the patients have had a recurrence. The PTD classification we propose is as follows: the dividing line between the proximal region (zone P) and the transitional region (zone T) is the line that links the point of the watershed between the left gastroepiploic artery and right gastroepiploic artery, to the point that is the inflow point of the first descending branch of the left gastric artery; and the dividing line between zone T and the distal region (zone D) is an arc at a radius of 8 cm from the pylorus. There were no lymphatic basins within the right gastric artery area for tumors located in zone T.Conclusion. The advantage of the PTD classification is that if the PTD classification were to be used as a guide for gastric resection procedures, preservation of the pylorus would become possible without diminishing the prognosis in patients with cT1N0 cancer located in zone T.