Abstract
The anatomic extent of tumor (TNM, pTNM) and, in case of treatment, the residual tumor status following treatment (residual tumor, or R classification) are the strongest predictors for outcome of patients with gastrointestinal cancer. The results of the pTNM and the R classifications depend on the methods used. In particular, the pN classification correlates with the number of nodes examined. The findings of micrometastases or isolated tumor cells in bone marrow should be indicated, and such cases must be analyzed separately from other metastatic cases. The same applies to patients with positive cytology in ascites fluid or peritoneal washings without gross involvement of the peritoneum. For the R classification the additional descriptors (conv), for conventional methods used, and (soph), for sophisticated, are recommended to indicate the methods used for classification. In general, long-term survival can be expected only after R0 resection (resection without residual tumor). The observed 5-year survival after R0 resection is 15% to 40% for esophageal carcinoma. 40% to 75% for gastric carcinoma, and 55% to 60% for colorectal carcinoma; the respective figures for R1 and R2 resections are only about 5% each. In R1 and R2 cases prognosis is determined primarily by the absence or presence of distant metastases, and pT and pN are of minor significance. After R0 resection there is a wide spectrum of prognoses. Careful pTNM classification allows a good estimation of the prognosis and can be considered the gold standard for any analysis of treatment results.
Résumé
L'étêndue anatomique (TNM, pTNM) et en cas de traitement, l'existence de tumeur résiduelle après traitement (classification R) sont les meilleurs facteurs pronostiques des cancers digestifs. Les résultats de la classification pTMN et R dépendent, cependant, des méthodes avec laquelles elles ont été déterminées. En particulier, la classification pN est bien corrélée avee le nombre de ganglions examinés. Les données concernant les micrométastases ou des cellules isolées dans la moelle doivent être notées et analysées à part. De même, la présence ou l'absence de cellules malignes dans l'ascite ou par le lavage de la cavité péritonéale (même en l'absence de nodules péritonéaux macroscopiquement visibles) doit être prise en compte. En ce qui concerne la classification R, il est important et recommandé d'indiquer ≪ (conv) ≫ (pur méthodes ≪ conventionnelles ≫ et ≪ (soph) ≫ (pour méthode ≪ sophistiquée ≫ sur le compte rendu. En général, on est en droit de s'attendre à une survie à long terme lorsque la résection a été considérée RO (sans tumeur résiduelle). La survie à 5 ans après une résection RO est d'environ 15–40% pour le cancer de l'oesophage, d'environ 40–75% pour le cancer gastrique et d'environ 55–60% pour le cancer colorectal. Les chiffres respectifs lorsque la résection étaient classée R1/2 sont globalement de 5%. Dans ces cas, le pronostic dépend plus de la présence ou l'absence de métastases à distance alors que pT et pN sont moins importantes. Après une résection RO, le pronostic est variable. La classification pTMN permet une bonne évaluation du pronostic et peut être considéré comme le ≪ gold standard ≫ pour toute analyse concernant la thérapeutique.
Resumen
La extensión anatómica del tumor (TNM, ptTNM) y, en caso de tratamiento, el status de tumor residual (tumor residual o clasificación R) son los más fuertes predictores del resultado en cáncer gastrointestinal. Los resultados de las clasificaciones pTNM y R dependen mucho de los métodos que se utilicen. En particular, la clasificación de pN se correlaciona con el número de ganglios examinados. Los hallazgos de micrometástasis o de células tumorales aisladas en la médula ósea deben ser registrados y tales casos deben ser analizados por separado de otros con metástasis. Lo mismo se aplica a los pacientes con citología positiva en el líquido ascítico o en el líquido de lavados peritoneals en pacientes que no exhiben afección del peritoneo. En cuanto a la clasificación R, la adición de los descriptores “(conv)” (que indica que se han utilizado métodos convencionales) y “(sof)” (que indica la utilización de métodos sofisticados) son recomendados a fin de indicar el método utilizado en la clasificación.
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Hermanek, P. pTNM and residual tumor classifications: Problems of assessment and prognostic significance. World J. Surg. 19, 184–190 (1995). https://doi.org/10.1007/BF00308624
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DOI: https://doi.org/10.1007/BF00308624