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le cancer de lestomac
Dr M Haoues
Classification de lUICC
D1 15
D2 25
(T N? M)
D1 15
D2 25
Au Japon
_______________________________________________________
Sige de la tumeur
D1 (N1)
D2 (N2)
D3 (N3)
_______________________________________________________
Tiers proximal
1-2-3-4
Tiers moyen
1-3-4-5-6
Tiers distal
3-4-5-6
5-6-7-8-9-10-11
2-7-8-9-10-11
1- 7-8-9
12-13-14-16
12-13-14-16
2-10-11-12-13-14-16
________________________________________________________________________________________________
La pomme de discorde.
Maruyama
___________________________________________________
Nb patients
Mortalit
Morbidit
Survie 5 ans
____________________________________________________
229
0,3%
19,6 %
II
III
70,5%
54,1%
____________________________________________________
NB
Nb moyen
patients de ganglions
Incidence
N+
Okajima
1995
125
12%
Furukawa
2000
110
10%
Mnig
2001
77
3( 0 8)
9,8 %
( 15 20%)
Comparaison
Nb patients
Morbidit
Survie 5ans
(P> 0,05)
(1985-1992)
GT
GT+S
90
97
39%
50%
36%
42%
YU
(1995-1999)
GT
GT+S
103
104
8%
15%
48%
54,8%
GT
GT+S
61
51
11,5%
27,5%
(P<0,05)
41%
39%
D1 (N1)
D2 (N2)
D3 (N3)
D4
_______________________________________________________
Tiers proximal
1-2-3-4
5-6-7-8-9-10-11
12-13-14-(16)
Tiers moyen
1-3-4-5-6
2-7-8-9-10-11
12-13-14-(16)
Tiers distal
3-4-5-6
1- 7-8-9
2-10-11-12-13-14-(16)
________________________________________________________________________________________________
D>N
R=0
D1
D2
D1
D2modifi
D3
D4
D2 + PAND
P ays
Nb patients
Morbidit
Mortalit
Survie 5ans
JCOG
(1995-2001)
Japon
D2 (n=263)
D2+PAND
(n=260)
20,9%
28,1%
P=0,067
0,8%
0,8%
P=0,99
69,2%
70,2%
P=0,85
Polonais
(1999-2003)
Pologne
D2 (n=141)
D2+PAND
(N=134)
27,7%
21,6
P=0,247
4,9%
2,2%
P=0,37
Asie
(1995-2002)
Jap; Core;
Chine
Taiwan
D2(n=135)
D2+PAND
(n=135)
26%
39%
P=0,023
0,7%
3,7%
P=0,107
52,6%
55,4%
P=0,801
Classification (2010)
Extent of lymph nodes mtastasis (N) Japanese and TNM classifications
______________________________________________________________
N
JC: 13th edition
TNM (6th edition)
JC 14th / TNM 7th
______________________________________________________________
N0
LN meta = 0
LN meta= 0
LN meta =0
N1
Group 1 LN meta
1 to 6 reg LN
1 to 2 reg LN
N2
Group 2 LN meta
7 to 15 LN
3 to 6 LN
N3
Group 3 LN meta
16 or more LN
7 or more LN
N3a: 7- 15 LN
N3b: 16 or more
_______________________________________________________________
Classification 2010
Depth of tumor penetration japanese and TNM classifications
____________________________________________________________
Depth of invasion (T)
JC 13th Ed
TNM 6 Ed
JC14th/ TNM 6th
____________________________________________________________
Mucosa /M Mucosa (M)
T1(M)
Tis/ T1
Tis/ T1a
Submucosa ( SM)
T1(SM)
T1
T1b
Muscularis propria (MP)
T2(MP)
T2a
T2
Subserosa (SS )
T2(SS)
T2b
T3
Pentration of serosa (SE)
T3
T3
T4a
Invasion of structures (SI)
T4
T4
T4b
____________________________________________________________