milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2024.4.48milmed-166Research ArticleОРИГИНАЛЬНЫЕ НАУЧНЫЕ ПУБЛИКАЦИИ. Лечебно-профилактические вопросыORIGINAL SCIENTIFIC PUBLICATIONS. Medical and preventive questionsОценка точности дооперационного определения глубины инвазии стенки желудка при местнораспространенном ракеASSESSMENT OF THE ACCURACY OF PREOPERATIVE DETERMINATION OF THE DEPTH OF WALL INVASION IN LOCALLY ADVANCED GASTRIC CANCERПотейкоА. И.PatseikaA. I.

Минск

РевтовичМ. Ю.ReutovichM. Yu.

Минск

КраськоО. В.KraskoO. V.

Минск

УО «Белорусский государственный медицинский университет»BelarusОбъединенный институт проблем информатики Национальной академии наук БеларусиBelarus202423082026044854Copyright © Потейко А.И., Ревтович М.Ю., Красько О.В., 20262026Потейко А.И., Ревтович М.Ю., Красько О.В.Patseika A.I., Reutovich M.Y., Krasko O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/166Цель

Цель: оценить целесообразность прогнозирования местной распространенности первичной опухоли при раке желудка (РЖ) на основании анализа дооперационных клинических данных.

Материалы и методы исследования: проведен ретроспективный анализ результатов лечения 1053 пациентов, радикально оперированных по поводу неметастатического РЖ. Изучена взаимосвязь предоперационных клинико-морфологических и лабораторных показателей с глубиной инвазии первичной опухолью стенки желудка (pT). Сравнение количественных показателей проводилось с помощью критерия Краскела-Уоллиса, при исследовании таблиц сопряжённости использовался критерий хи-квадрат, в случае нарушения предположений, лежащих в основе критерия хи-квадрат, использовался точный критерий Фишера.

Результаты исследования

Результаты исследования: Совпадение значений сТ и рТ имеет место только в 58,8 % случаев, при этом в 23 % случаях, определенных как cT2-3, истинная глубина инвазии соответствовала pT1, а 31 % случаев, определенных как cT2-3, оказались в последующем классифицированными как pT4. Установлено, что выход первичной опухоли за пределы слизисто-подслизистого слоя стенки желудка чаще встречается: при инфильтративных опухолях в сравнении с экзофитными; при некогезивной аденокарциноме (high grade) в сравнении с когезивной (low grade); при тотально-субтотальном поражении желудка в сравнении с менее распространенным поражением желудочной стенки. Оценка изменений ряда лабораторных показателей (абсолютных значений тромбоцитов, лейкоцитов, нейтрофилов, их соотношений, а также уровня фибриногена) подтвердила ранее описанную в ряде исследований взаимосвязь с глубиной инвазии первичной опухолью стенки желудка.

Заключение

Заключение. Наличие взаимосвязи ряда клинико-морфологических и лабораторных показателей с глубиной инвазии стенки желудка создает предпосылки для разработки и применения прогностических моделей с целью повышения точности предоперационного Т-стадирования.

Objective

Objective: To evaluate the feasibility of predicting the local extent of the primary tumor in gastric cancer (GC) based on the analysis of preoperative clinical data.

Materials and methods

Materials and methods: A retrospective analysis of the results of treatment of 1054 patients who underwent radical surgery for non-metastatic GC was carried out. The relationship between preoperative clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall by the primary tumor (pT) was studied. Comparison of quantitative indicators was carried out using the Kruskal-Wallis test; when examining contingency tables, the chi-square test was used; in case of violation of the assumptions underlying the chi-square test, Fisher’s exact test was used.

Results

Results: The coincidence of cT and pT values occurs only in 58.8 % of cases, while in 23 % of cases defined as cT2-3, the true depth of invasion corresponded to pT1, and 31 % of cases defined as cT2-3 were in subsequently classified as pT4. It has been established that the growth of the primary tumor beyond the mucous-submucosal layer of the stomach wall is more common: with infiltrative tumors in comparison with expansive growth pattern; with non-cohesive adenocarcinoma (high grade) in comparison with cohesive (low grade); with total-subtotal damage to the stomach in comparison with less widespread damage. Evaluation of changes in a number of laboratory parameters (absolute values of platelets, leukocytes, neutrophils, their ratios, as well as fibrinogen levels) confirmed the relationship with the depth of invasion of the gastric wall by the primary tumor previously described in a number of studies.

Conclusion

Conclusion: The presence of a relationship between a number of clinical, morphological and laboratory parameters and the depth of invasion of the gastric wall creates prerequisites for the development and application of prognostic models in order to increase the accuracy of preoperative T-staging.

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The authors declare that there are no conflicts of interest present.