Ömer YERCİ, Halil ÖZGÜÇ, Nusret KORUN, Erol BAĞÇIVAN, Yalçın SÖNMEZ, Ersin ÖZTÜRK, Türkay KIRDAK

Can modified Dukes' classification be used in gastric cancer staging?

Amaç: Dukes evreleme sistemi kolorektal kanser evrelemesinde yaygın olarak kullanılan basit bir evreleme sistemidir. Bu çalışma modifiye Dukes sınıflamasının mide kanseri olgularında uygulanabilirliğini araştırmak amacıyla düzenlenmiştir. Yöntemler: Cerrahi de en az 15 lenf nodülü çıkarılmış 139 mide kanserli olgunun yaşam sürelerine etkili faktörler analiz edildi. Modifiye Dukes ve TNM evrelerinin bu prognostic faktörlerle olan korelasyonu saptandı. Araştırılan faktörler yaş, tümor büyüklüğü, histolojik tip, diferansiasyon, lokalizasyon, çıkartılan lenf nodülü sayısı, metastatik lenf nodülü sayısı ve metastatik lenf nodülü sayısının çıkartılan lenf nodülü sayısına oranıdır. Bulgular: Tümör çapının 10 cm'den büyük olması, muskularis propria and seroza invazyonu, metastatik lenf nodülü sayısının 6'dan büyük olması, metastatik lenf nodülü oranının 0.29'dan büyük olması çok yönlü analizde istatistiksel anlamlı kötü prognostic faktörler olarak bulundu. Her iki evreleme sistemi de bu faktörlerle korelasyon gösteriyordu. Receiver operating characteristics curves (ROC) analizinde her iki evreleme sistemi arasında istatistiksel fark yoktu. Sağ kalım eğrileri incelendiğinde Dukes evrelemesi TNM'ye gore daha basamaklı bir eğriye sahipti. Sonuç: Dukes evreleme sistemi mide kanserindeki prognostic faktörlerle korelasyon göstermektedir. Kolayca akılda tutulabilir. Dukes A stage evresi iyi prognoza sahip bir grubu tanımlar. T2N0 hastaların erken mide kanseri olarak tanımlanması ayrıca incelenmesi gereken bir konudur.

Modifiye Dukes sınıflaması mide kanseri evrelemesinde kullanılabilir mi?

Aim: Dukes' staging system is a simple system used widely in the staging of colorectal cancer. This study was designed to analyze the applicability of the modified Dukes' classification system in gastric cancer cases. Methods: The prognostic factors affecting survival in 139 gastric cancer cases who had had at least 15 lymph nodes removed were analyzed. Modified Dukes' and TNM classifications were investigated to correlate statistically significant prognostic factors. The investigated prognostic factors were age, tumor size, histological type, differentiation, localization and number of the lymph nodes removed, and the ratio of number of metastatic lymph nodes to the number of lymph nodes removed. Results: Tumor size >10 cm, muscularis propria and serosa invasion, >6 invaded lymph nodes and metastatic lymph node ratio >0.29 were statistically significant poor prognostic factors in multivariate analysis. The two staging systems were in correlation with these poor prognostic factors. There was no statistical difference between receiver operating characteristics curves of the two systems. When the survival curves were examined, it was seen that Dukes' staging had a more stepwise curve than the TNM system. Conclusion: Dukes' staging system is in correlation with prognostic factors in gastric cancer. It can be easily recalled. Dukes' A stage when applied to gastric cancer defines a good prognosis group. The reclassification of T2N0 tumors as early gastric cancer is an area of speculation which needs to be investigated separately.

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