www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [22/04/2026 01:24:50] http://www.medenosrce.net/arhimed/poglej.asp?id=151 PROGNOSTICNI POMEN ZASEVKOV V BEZGAVKAH PRI RAKU ŽELODCA: PRIMERJAVA NOVE (5. IZDAJE) IN STARE (4. IZDAJE) TNM KLASIFIKACIJE RAKA ŽELODCA Avtor: Primož Sever Mentor: doc. dr. Mirko Omejc IZHODIŠCE: Rak želodca predstavlja še vedno enega najpogostejših vzrokov smrti med malignimi obolenji prebavil. Kirurško zdravljenje je zaenkrat edini uspešen nacin zdravljenja raka želodca. Cilj je doseci R0 resekcijo (ni rezidualnega tumorja) z ustrezno limfadenektomijo. Osnova za ocenjevanje prognoze, posredovanje in primerjavo rezultatov zdravljenja bolnikov z rakom želodca omogoca TNM klasifikacija. N kategorija (ocena zasevkov v regionalnih bezgavkah) 4. izdaje TNM klasifikacije, iz leta 1987, je temeljila na oddaljenosti zasevkov od primarnega tumorja, pri zadnji, 5. izdaji, TNM klasifikacije, iz leta 1997, pa temelji na številu pozitivnih bezgavk. NAMEN IN HIPOTEZA: Namen raziskovalne naloge je bil ugotoviti, ce obstaja razlika v prognozi za bolnika obolelega z rakom želodca v primerih, ko se stadij bolezni ocenjuje po stari ali novi TNM klasifikaciji. V znanstvenih krogih se še vedno veliko razpravlja o tem, katera izmed klasifikacij je primernejša, zato sem poizkušal preveriti naslednjo hipotezo: TNM klasifikacija raka želodca iz leta 1997 omogoca bolj natancno postavitev prognoze z rakom želodca obolelih bolnikov kot klasifikacija iz leta 1987, saj je število pozitivnih bezgavk pomembnejši prognosticni dejavnik od oddaljenosti le-teh. METODE: V raziskavo so bili vkljuceni bolniki z rakom na želodcu, pri katerih je bila narejena kurativna R0 resekcija želodca z ustrezno limfadenektomijo in patohistološko pregledanimi vsaj petnajstimi bezgavkami. Z enotnim klinicno - patološkim protokolom so bili prospektivno zbrani potrebni podatki. Podatke sem statisticno obdelal s programom SPSS v. 10.0, krivuljo preživetja izracunal po Kaplan - Meierjevi metodi, pomen prognosticnih dejavnikov sem ovrednotil z univariatno analizo, statisticni pomen le-teh pa dolocil z log-rank testom. REZULTATI: Izbranim kriterijem je ustrezalo 376 bolnikov. Po primerjavi med staro in novo klasifikacijo je prišlo do migracij bolnikov med pN kategorijami in posledicno tudi med stadiji. Pri primerjavi petletnega preživetja sem ugotovil, da imata obe klasifikaciji podobno prognosticno vrednost skupin pN1 in pN2. Prednost nove klasifikacije je razvrstitev bolnikov v pN3 skupino, z izredno slabo prognozo, ki vsebuje 16,8% bolnikov z opravljeno R0 resekcijo in z zasevki v regionalnih bezgavkah. ZAKLJUCKI: Na podlagi dobljenih rezultatov smo potrdili našo hipotezo, da omogoca 5. izdaja TNM klasifikacije bolj natancno postavitev prognoze z rakom želodca obolelih bolnikov kot 4. izdaja TNM klasifikacije. K vecji prognosticni vrednosti 5. izdaje TNM klasifikacije pripomore uvedba nove pN3 skupine znotraj N kategorije in za posameznega bolnika natancnejša klasifikacija znotraj N kategorije. «» [Abstract / English version] PROGNOSTICNI POMEN ZASEVKOV V BEZGAVKAH PRI RAKU ŽELODCA: PRIMERJAVA NOVE (5. IZDAJE) IN STARE (4. IZDAJE) TNM KLASIFIKACIJE RAKA ŽELODCA Author: Primož Sever Mentor: doc. dr. Mirko Omejc BACKGROUND: Gastric carcinoma is one of the most common causes of death in malignant diseases in gastrointestinal tract. Surgery, among other possibilities, is for now the only successful treatment. The aim of treatment is R0 resection (no evidence of tumor) with appropriate lymphadenectomy. The TNM classification has become the principal method for assessing the prognosis for cancer patients and to provide a reliable means for reporting and comparing the results of treatments. The 4th edition of TNM classification from the year 1987 was based on the distance of the metastatic nodes from primary tumor. The new 5th edition of TNM classification from year 1997 is based on the number of positive lymph nodes metastasis. AIM AND HYPOTHESIS: Aim of the study was to evaluate, if this new TNM classification gives the same prognostic information as the previous classification. Which of the two classifications is better is still under discussion so I tested the next hypothesis: The 5th edition of TNM classification for gastric cancer is better for assessing the prognosis of gastric cancer patients than the 4th edition of classification. The number of positive lymph nodes has a higher prognostic value than the distance of the metastatic nodes from primary tumor. METHODS: The study was based on patients who underwent R0 resection with appropriate lymphadenectomy and with 15 or more dissected lymph nodes. With uniform clinico-pathological protocol the necessary data was gathered. Data was statistically analyzed with the computer program SPSS v. 10.0. Survival time was computed with Kaplan-Meier method. The significance of prognostic factors was evaluated with univariat analysis and their statistic meaning was defined with log-rank test. RESULTS: Overall 376 patients were eligible for the study. Many patients classified with old classification were up- and down- staged after they were reclassified with new classification. The study showed that patients who were in categories pN1 and pN2 selected by different criteria in both versions of TNM classification have similar survival probabilities. The advantage of the 5th edition is a new category pN3 with patients with significantly poor prognosis. CONCLUSIONS: The above mentioned results proved our hypothesis. The 5th edition of TNM classification is better for assessing the prognosis of gastric cancer patients than the 4th edition of classification. The new pN3 group of N category gives 5th edition higher prognostic value and patients are more accurately classified inside of N category.