横结肠系膜浸润胃癌T分期的合理性分析  

Evaluation of the rationality of current T staging of gastric cancer with transverse mesocolon invasion

作　　者：吴晖[1] 徐萍萍[1] 何裕隆[1] 徐建波[1] 蔡世荣[1] 张信华[1] 王亮[1] 杨东杰[1] 詹文华[1] 

机构地区：[1]中山大学附属第一医院胃肠胰外科中山大学胃癌诊治中心,广州510080

出　　处：《中华肿瘤杂志》2014年第1期43-47,共5页Chinese Journal of Oncology

摘　　要：目的评估目前横结肠系膜浸润胃癌T分期的合理性。方法行手术治疗的T4期原发性胃癌808例，根据脏器浸润情况分为无浸润组（穿透浆膜的T4a期胃癌）638例，非系膜组（横结肠系膜以外单个脏器浸润的T4b期胃癌）126例，系膜组（仅横结肠系膜浸润）44例，比较3组患者的临床病理特征、手术方式和预后。结果无浸润组、非系膜组和系膜组患者的性别、年龄、淋巴结转移率、肝转移率、肿瘤Borrmann分型、病理类型、分化程度、血清癌胚抗原水平比较，差异均无统计学意义（均P〉0．05）。无浸润组、非系膜组和系膜组患者的肿瘤直径i〉5cm者分别占39．0％、61．1％和54．5％，差异有统计学意义（P〈0．05）。无浸润组、非系膜组和系膜组患者的远处转移率分别为11．9％、30．2％和43．2％，差异有统计学意义（P〈0．05）。无浸润组、非系膜组和系膜组患者的腹膜种植转移率分别为8．2％、26．2％和38．6％，差异有统计学意义（P〈0．05）。无浸润组、非系膜组和系膜组患者的Ⅳ期患者分别占25．4％、84．7％和93．7％，差异有统计学意义（P〈0．05）。无浸润组、非系膜组和系膜组患者的根治性切除率分别为92．0％、69．8％和77．3％，差异有统计学意义（P〈0．05）。系膜组的肿瘤直径、远处转移率、腹膜种植率、TNM分期和手术方式与无浸润组比较，差异均有统计学意义（均P〈0．0167）；系膜组的肿瘤直径、远处转移率、腹膜种植率、TNM分期和手术方式与非系膜组比较，差异均无统计学意义（均P〉0．0167）。无浸润组、非系膜组、系膜组患者的中位生存时间分别为42．0、16．4和19．0个月，差异有统计学意义（均P〈0．01）；无浸润组患者的中位生存时间长于非系膜组和系膜组，差异均有统计学意义（均P〈0．01），非系膜组和系膜组患者的中位生�Objective To evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion. Methods Data of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University, from April 1996 to October 2009. According to the information of transverse mesocolon invasion, all cases were divided into groups NOI （T4a stage, non organ invasion, n = 638）, NTMI （T4b stage, non transverse mesolon invasion, with organ invasion, n = 126）, and TMI （transverse mesocolon invasion, n =44）. The clinicopathological features, surgical procedure and prognosis were compared among the three groups. Results No significant difference was found in gender, age, lymph node metastasis, hepatic metastasis, tumor＇s Borrmann type, histological type, differentiation degree, value of serum CEA among the 3 groups （ all P 〉 0.05 ）. In the groups NOI, NTMI and TMI, the ratio of mean tumor diameter ≥5 cm was 39.0% （249/638）, 61.1% （77/126） and 54.5% （24/44）, respectively; the ratio of distal metastasis was 11.9% （76/638）, 30.2%（38/126） and 43.2% （19/44）, respectively; the ratio of peritoneal metastasis was 8.2% （52/638）, 26.2% （33/126） and 38.6% （ 17/44）, respectively; the ratio of TNM IV stage was 25.4% （ 162/638）, 84.7% （107/126） and 93.7% （41/44） , respectively; and the ratio of radical resection was 92.0% （587/638）, 69.8% （88/126） and 77.3% （34/44）, respectively; all with significant differences （P 〈 0.01）, and the results of pairwise comparisons （Bonferroni correction, significant level a = 0. 05/3 = 0. 0167） showed that these parameters were significantly different between groups NOI and TMI （P 〈 0. 0167 ） , but non-significant between groups NTMI and TMI （P 〉 0. 0167 ）. The median survival time was 42.0, 16.4 and 19.0 months in the groups NOI, NTMI and TMI, respectively （P 〈0.01 ） , and the results of pairwise comparison showed that the pro

关 键 词：胃肿瘤 病理学 临床 外科手术 预后 临床分期 

分 类 号：R735.2[医药卫生—肿瘤]