作者：黄泽平1，沈渭奇2，田琦民2，曾祥挺1、2，李梅1，汪文杰1，陈康1，姚亚东1

单位：1. 兰州大学第二医院 普通外科三病区（胃肠外科），甘肃 兰州 730030；2. 兰州大学第二临床医学院，甘肃 兰州 730030

Authors: Huang Zeping1，Shen Weiqi2，Tian Qimin2，Zeng Xiangting1，Li Mei1，Wang Wenjie1，Chen Kang1，Yao Yadong1

Unit: 1.Department of General Surgery, Lan Zhou University Second Hospital, Lanzhou 730030, Gansu, China；2.The second Clinical Medical College, Lanzhou University, Lanzhou 730030, Gansu, China

摘要：

目的 评估基于淋巴结比率(LNR)所建立的新的rAJCC TNM分期预测模型(rAJCC分期系统)在临床中的应用价值。方法 收集兰州大学第二医院诊断为非转移性胃癌并进行了D2淋巴结清扫术的患者数据，分别利用AJCC及rAJCC分期系统对患者进行分期并比较，评估rAJCC的rN分期与第八版AJCC分期的每个N分期对患者预后的影响。结果 以LNR截点重新定义AJCC N分期，rN0、 rN1、 rN2、 rN3a和rN3b对应的5年OS率分别为71.9%、56.6%、52.3%、34.3%和33.1%(log-rank检验P<0.01)，而rAJCC rN分期各期患者的5年OS率分别为84.6%(rⅠA期)、77.4%(rⅠB期)、43.8%(rⅡA期)、71.1%(rⅡB期)、37.4%(rⅢA期)、56.3%(rⅢB期)和27.4%(rⅢC期)(log-rank检验P<0.001),rAJCC分期系统的判别能力和预后同质性同比均优于第八版AJCC分期。结论 基于LRN的新的rAJCC TNM分期预测模型在胃癌患者的分期及对患者的预后预测能力上具有一定优势，对胃癌患者的临床管理具有指导意义。

关键词：胃癌；淋巴结比率；淋巴结分期；总生存期；预后

Abstract：

Objective Evaluate the application value in the clinical practice of the new rAJCC TNM prediction model （rAJCC staging system）. Method Collect the data from the patients diagnosed with non[1]metastatic gastric cancer in the Second Hospital of Lanzhou University after D2 lymph node dissection. Patients were staged and compared by the AJCC and rAJCC staging systems respectively. Assess the prognostic impact of each N stage in the new rAJCC stage and the eighth edition AJCC. Result According to the LNR cut-off point，the rAJCC staging rate was 71.9%, 56.6%, 52.3%, 34.3%, and 33.1% （log）, and the corresponding 5-year OS rates of rN0, rN1, rN2, rN3a, and rN3b were 71.9%, 56.6%, 52.3%, 34.3%, and 33.1%, respectively. -rank test P<0.01）. Based on rN staging, the 5-year OS rates of patients in each stage of rA JCC are 84.6% （rⅠA stage）, 77.4% （rⅠB stage）, 43.8% （rⅡA stage）, 71.1% （rⅡB stage）, 37.4% （rⅢA stage）, 56.3% （rⅢB stage ） and 27.4% （rⅢC stage ） （log -rank test P<0.001）.The distinguishing ability and prognostic homogeneity of rAJCC staging are better than those of the eighth edition of AJCC staging. Conclusion The rAJCC TNM prediction model based on LNR performs well in the prognosis prediction and evaluation of gastric cancer patients and is instructive for the clinical management of gastric cancer patients.

Key Words: Gastric cance；Lymph node ratio；Lymph node staging；Overall survival；Prognosis