75例胃癌病理分型对其预后的影响评价  

Effects of pathological classification on the prognosis of gastric cancer： a report of 75 cases

作　　者：雷音[1] 韦佳明[2] 黄林平[2] 

机构地区：[1]北京市和平里医院普外科,100013 [2]卫生部中日友好医院普外科

出　　处：《临床外科杂志》2013年第9期684-686,共3页Journal of Clinical Surgery

摘　　要：目的 探讨不同病理分型胃癌的病理特征对临床预后的影响,为临床的治疗及预后判断提供指导.方法 采用美国癌症联合委员会（AJCC） 2009年底发布的第7版胃癌分期法,对卫生部中日友好医院2003年1月至2005年12月收治的75例胃癌术后病例重新进行分型.分别以分化程度和肿痛大小进行分组,比较各组间的浆膜浸润率、淋巴结转移率；并比较新旧两版分期对随访患者5年生存率的影响.结果 不同分化程度的胃癌淋巴结转移率及浆膜浸润率比较,差异有统计学意义；高分化腺癌与中、低分化腺癌及印戒细胞癌的淋巴结转移率及浆膜浸润率比较,差异有统计学意义.将各分化组叠加,以肿瘤最大径≤4 cm和＞4 cm重新分组,见肿瘤最大径≤4 cm组与最大径＞4 cm组淋巴结转移率、浆膜浸润率的差异有统计学意义.75例可随访病历以新旧两版分别分期,新旧两版分期均可见分期越差,5年生存率越低.结论 第7版AJCC胃癌分期法较旧版Ⅱ、Ⅲ期患者明显增多,而Ⅰ、Ⅳ期患者相应减少,为临床对更多的胃癌患者术后施行放化疗提供了支持,从而使更多胃癌患者受益.Objective To estimate the effects of different pathological features on the prognosis of gastric cancer and guide the clinical treatment and prognostic judgement.Methods According to the 7th edition of gastric cancer staging published by the American Joint Committee on Cancer （AJCC）in late 2009,75 gastric cancer patients treated in the China-Japan Friendship Hospital from January 2003 to December 2005 were re-classified.The patients were divided into groups according to the degree of differentiation and tumor size.The rate of serosal invasion and lymph node metastasis were compared between the groups.The influence of different versions of classification on the 5-year survival rate was also analysed.Results The differentiation of lymph node metastasis and serosal invasion rate in different types of gastric cancer was statistically significant; the lymph node metastasis rate and serosal invasion in well-differentiated was significantly different from those in poor-differentiated adenocarcinoma and signet ring cell carcinoma.According to the size of tumor,all cases were re-grouped.In the respects of lymph node metastasis and serosal infiltration rate,those tumors with a maximum tumor diameter ≤ 4 cm were significantly different from those with a diameter ＞ 4 cm.It was found that the poor stage was related with the low 5-year survival in both versions of pathological classification.Conclusion Compared with the 6th edition of gastric cancer staging,the 7th edition was revised on tumor staging.Patients with Phase Ⅱ and Ⅲ are significantly increased and patients with Phase Ⅰ and Ⅳ are reduced accordingly.It allows more radiotherapy and chemotherapy,which may benefit more patients with gastric cancer.

关 键 词：胃癌 病理 转移 预后 

分 类 号：R735.2[医药卫生—肿瘤]