淋巴结转移是影响胃癌患者预后的重要因素之一,准确判断胃癌淋巴结转移状态对评估患者预后至关重要。pN分期作为临床最常用的淋巴结分期系统,由于存在阶段性分期偏倚,在一定程度上影响患者术后辅助治疗及预后评估。为解决这一问题,国内外学者提出用淋巴结转移率来评价胃癌患者的预后,但概念的混乱和淋巴结转移率分期临界值的不一致对其在临床推广应用产生一定影响。目前,淋巴结转移率分期及其对患者生存预测的价值仍是研究的一大热点。
Lymph node metastasis is one of the important factors affecting the prognosis of gastric cancer patients. It is very important to accurately determine the status of lymph node metastasis in gastric cancer patients. pN staging is the most commonly used lymph node staging system in clinic. Due to stage bias, it affects postoperative adjuvant therapy and prognosis assessment to some extent. In order to solve this problem, domestic and foreign scholars proposed to use lymph node metastasis rate to evaluate the prognosis of gastric cancer patients, but the confusion of concepts and the inconsistent staging threshold of lymph node metastasis rate have a certain impact on its clinical application. At present, lymph node metastasis rate and stage and its value in predicting patient survival are still a hot research area.
胃癌,淋巴结转移率,淋巴结转移率分期,生存预测价值, Gastric Cancer Metastatic Lymph Node Ratio Lymph Node Metastatic Ratio Stage
Predictive Value of Survival摘要
Lymph node metastasis is one of the important factors affecting the prognosis of gastric cancer patients. It is very important to accurately determine the status of lymph node metastasis in gastric cancer patients. pN staging is the most commonly used lymph node staging system in clinic. Due to stage bias, it affects postoperative adjuvant therapy and prognosis assessment to some extent. In order to solve this problem, domestic and foreign scholars proposed to use lymph node metastasis rate to evaluate the prognosis of gastric cancer patients, but the confusion of concepts and the inconsistent staging threshold of lymph node metastasis rate have a certain impact on its clinical application. At present, lymph node metastasis rate and stage and its value in predicting patient survival are still a hot research area.
Keywords:Gastric Cancer, Metastatic Lymph Node Ratio, Lymph Node Metastatic Ratio Stage, Predictive Value of Survival
肿瘤分期是评价肿瘤生物学行为的最重要指标之一,是根据原发肿瘤数量以及在个体内扩散程度来描述肿瘤的严重程度和侵及范围的过程 [4]。当前,世界上常用的胃癌分期方法有三种,即JGCA (Japanese Gastric Cancer Association,日本胃癌学会)的“胃癌处理规约”、UICC (International Union for Cancer Control,国际抗癌联盟)/AJCC (American Joint Committee on Cancer,美国癌症联合会)的TNM分期以及TRM分期系统 [5]。目前,中国胃癌分期标准主要参照第8版AJCC/UICC的TNM分期,其N分期按照区域阳性淋巴结的枚数来划分。在之前的淋巴结取材定为15枚,但在第15版日本《胃癌处理规约》 [6] 中规定:N的确定推荐取材16枚以上的淋巴结,即使不足16枚仍要进行N的分类,但是在手术中往往是不足15或是16枚的,有限的淋巴结切除可能提供不恰当的分期,易出现分期偏倚现象 [7]。有研究表明 [8] ,仅行胃淋巴结清扫(D1)的患者N分期的准确性会受到影响,造成N分期偏倚,这种偏倚可达10%~15%,由于pN是影响胃癌预后的重要因子,pN的不同对于疗效及预后的评估也不同。
满孝丽,李小宝. 胃癌淋巴结转移率分期及其生存预测价值的研究现状Research Status of Lymph Node Metastasis Rate Stage and Predictive Value of Survival in Gastric Cancer[J]. 临床医学进展, 2021, 11(09): 4155-4159. https://doi.org/10.12677/ACM.2021.119606
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