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目的:探讨pT2期胃癌根据固有肌层浸润深度进一步分期为pT2a期和pT2b期在胃癌预后评估中的临床价值。方法:按照国际抗癌联盟和美国癌症联合会提出的第8版胃癌TNM分期系统，从2008年1月1日至2015年1月1日在河北医科大学第四manbet官网登录 行根治性手术治疗的胃癌患者中，筛选出术后病理T分期为pT2期的患者，根据肿瘤浸润深度的不同分为pT2a期组(侵犯浅肌层)和pT2b期组(侵犯深肌层)，比较两组患者的无病生存和总生存情况。结果:1 411例术后病理T分期为pT2期的患者中位随访68.8个月，1 347例(95.46%)获得完整随访资料，5年无病生存率为67.83%，5年总生存率为65.85%。709例pT2a期组患者5年无病生存率为73.91%，5年总生存率为72.50%；638例pT2b期组患者5年无病生存率为61.13%，5年总生存率为58.46%，两组之间5年无病生存率和总生存率差异有统计学意义(均 P<0.001)。按照N分期进行分层分析，pT2aN0M0(274例)、pT2aN1M0(192例)、pT2aN2M0(147例)、pT2aN3aM0(59例)和pT2aN3bM0(37例)患者的5年无病生存率分别为84.67%、77.08%、67.35%、54.24%和35.14%，5年总生存率分别为83.58%、72.40%、68.71%、54.24%和35.12%。pT2b期组患者中，pT2bN0M0(209例)、pT2bN1M0(166例)、pT2bN2M0(127例)、pT2bN3aM0(78例)和pT2bN3bM0(58例)患者的5年无病生存率分别为80.86%、69.28%、54.33%、35.90%和15.52%，5年总生存率分别为76.08%、62.05%、56.69%、37.18%和17.24%。N分期为N0、N1期时，pT2a期组与pT2b期组患者的5年无病生存率差异无统计学意义( P值分别为0.199和0.090)；N分期为N2、N3a、N3b期时，pT2a期组与pT2b期组患者的5年无病生存率差异有统计学意义( P值分别为0.027、0.022和0.025)；在N分期相同的情况下，pT2a期组患者的总生存率均优于pT2b期组( P值分别为0.023、0.034、0.034、0.043和0.018)。 结论:固有肌层浸润深度不同的pT2期胃癌患者预后存在明显差异，根据固有肌层浸润深度分为pT2a期和pT2b期，并结合淋巴结转移数目，将可以更加精准评估pT2期胃癌患者的预后。

Objective:To investigate the clinical value of pT2 gastric cancer staging pT2a and pT2b according to the depth of muscularis propria invasion in evaluating the prognosis of gastric cancer.Methods:According to the 8th edition of TNM staging system for gastric cancer proposed by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), patients with gastric cancer who underwent radical surgery in the Fourth Hospital of Hebei Medical University from January 1, 2008 to January 1, 2015 were selected and divided into pT2a and pT2b stage group according to the depth of tumor invasion. The 5-year overall survival (OS) and disease-free survival (DFS) were compared between the two groups.Results:The median follow-up time of 1 411 patients with postoperative pathological pT2 stage was 68.8 months, and 1 347 patients (95.46%) received complete follow-up data. The 5-year OS rate was 65.85%, and the 5-year DFS rate was 67.83 %. The 5-year OS rate and 5-year DFS rate of 709 pT2a patients were 72.50% and 73.91%, respectively. The 5-year OS rate and 5-year DFS rate of 638 pT2b patients were 58.46% and 61.13%, respectively, significantly different from those of the pT2a group ( P<0.001). Hierarchical analysis was performed according to N staging. The 5-year OS rates of pT2aN0M0 (274 cases), pT2aN1M0 (192 cases), pT2aN2M0 (147 cases), pT2aN3aM0 (59 cases) and pT2aN3bM0 (37 cases) were 83.58 %, 72.40 %, 68.71 %, 54.24 % and 35.12 %, respectively. The 5-year DFS rates were 84.67 %, 77.08 %, 67.35 %, 54.24 % and 35.14 %, respectively. In the pT2b group, the 5-year OS rates of pT2bN0M0 (209 cases), pT2bN1M0 (166 cases), pT2bN2M0 (127 cases), pT2bN3aM0 (78 cases) and pT2bN3bM0 (58 cases) were 76.08%, 62.05%, 56.69%, 37.18% and 17.24%, respectively, and the 5-year DFS rates were 80.86%, 69.28%, 54.33%, 35.90% and 15.52%, respectively. Under the same N stage, the OS rates of patients in the pT2a group were better than those in the pT2b group ( P values were 0.023, 0.034, 0.034, 0.043 and 0.018, respectively). When the N stage was N0 and N1, there was no significant difference in the 5-year DFS rate between the pT2a group and the pT2b group ( P values were 0.199 and 0.090, respectively). When the N stages were N2, N3a and N3b, the difference between the pT2a stage group and the pT2b stage group was statistically significant ( P values were 0.027, 0.022 and 0.025, respectively). Conclusions:In the 8th edition of AJCC/UICC gastric cancer staging system, pT2 stage can be divided into pT2a stage (invasion of superficial muscularis) and pT2b stage (invasion of deep muscularis) according to the infiltration depth of muscularis propria. There are significant differences in prognosis between the two groups. Combined with the number of lymph node metastasis, the prognosis of patients with pT2 gastric cancer can be more accurately evaluated.