ＤｕｋｅｓＣ大腸癌におけるリンパ節転移分類の検討：日本大腸癌取扱い規約とＴＮＭ分類の比較

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  • Prognostic Significant of TNM Classification in the Regional Lymph Node Metastases of Colorectal Carcinoma: Comparison with Japanese General Rules

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The Japanese General Rules for Clinical and Pathological Studies on Cancers of the Colon, Rectum and Anus (JGR) in Japan and the TNM staging system of the American Joint Committee on Cancer/the Union Internationale Contrele Cancer (AJCC/UICC) in Europe and the United States are widely used for the staging of colorectal cancer. This study was aimed at clarifying the relationships between the JGR and TNM classifications of lymph nodes and the prognosis in patients with Dukes C colorectal cancer, and at examining which classification was more appropriate. The subjects were 386 Dukes C colorectal cancer patients who had undergone curative resection. The n-stage in JGR based on the anatomical sites of metastatic lymph nodes, the N-stage in the new TNM classification based on the number of metastatic lymph nodes, and the existing clinicopathological parameters (gender, age, tumor diameter, region occupied by tumor, histological type, depth of invasion, lymphangial invasion, and venous invasion) were analyzed for prognostic significance for survival by multivariate analysis. Univariate analysis showed that 6 factors, namely, tumor diameter, depth of invasion, lymphangial invasion, venous invasion, JGR (n-stage), and TNM (N-stage) were significant prognostic factors for 5-year survival. However, multivariate analysis showed that only the TNM classification of lymph node metastasis was an independent prognostic factor in patients with Dukes C colorectal cancer (p<0.0001, with an odds ratio of 2.876). In the Dukes C colorectal cancer patients who had undergone systemic lymph node dissection, the N-stage classification of TNM seemed more appropriate than the n-stage classification of JGR, which is based on the anatomical sites of metastatic lymph nodes.

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