Tachibana M, Takemoto Y, Monden N, Nakashima Y, Kinugasa S, Dhar D K, Kotoh T, Kubota H, Kohno H, Nagasue N
Department of Surgery, Masuda Medical Association Hospital, Japan.
Eur J Surg. 1999 Apr;165(4):319-25. doi: 10.1080/110241599750006848.
To evaluate 100 patients with early gastric cancer from the point of view of early detection, clinicopathological variables, and long term results.
Retrospective study.
Rural general hospital, Japan.
100 patients with early gastric cancer (confined to the epithelium, lamina propria, or submucosa) out of a total of 197 who had gastric cancers resected for cure between May 1986 and April 1996.
Subtotal gastrectomy (n = 87), total gastrectomy (n = 8), proximal gastrectomy (n = 2), and local wedge resection (n = 3).
Histopathological features and outcome.
The mean annual incidence of early gastric cancer was 51% (range 35%-70%). 16/59 patients with mucosal cancer (37%) and 18/41 with submucosal cancer (44%) presented with symptoms of the disease. The diagnosis was made in 62 by endoscopy, and in only 2 by upper gastrointestinal radiographic examination. None of the 59 with mucosal cancer had lymphatic invasion, and only 1 had a lymph node metastasis. Among the 41 with submucosal cancer, however, 15 had lymphatic invasion (37%), 13 had venous invasion (32%), and 2 had lymph node metastases (5%). 83 patients were alive with no sign of recurrence at the time of writing (median follow up 62 months, range 12-136). One patient with a tumour that produced alpha-fetoprotein died of hepatic metastases 23 months after subtotal gastrectomy. 9 patients developed second cancers, and 6 died of these with no signs of recurrence of early gastric cancer. The overall 5 and 10 year survival rates were 82% and 66%, and the corresponding disease-specific survival rates for 85 patients were both 98%.
Excellent long term results can be achieved in the treatment of early gastric cancer, even in a non-specialist centre. Patients with early gastric cancer should have their alpha-fetoprotein concentration measured, and be examined for the presence of other malignant disease both before and after treatment of the gastric cancer.
从早期发现、临床病理变量及长期结果的角度评估100例早期胃癌患者。
回顾性研究。
日本乡村综合医院。
1986年5月至1996年4月间因治愈性目的行胃癌切除术的197例患者中的100例早期胃癌患者（肿瘤局限于上皮层、固有层或黏膜下层）。
胃次全切除术（n = 87）、全胃切除术（n = 8）、近端胃切除术（n = 2）及局部楔形切除术（n = 3）。
组织病理学特征及结果。
早期胃癌的年平均发病率为51%（范围35% - 70%）。59例黏膜癌患者中有16例（37%）、41例黏膜下癌患者中有18例（44%）出现疾病症状。62例通过内镜检查确诊，仅2例通过上消化道造影检查确诊。59例黏膜癌患者均无淋巴侵犯，仅1例有淋巴结转移。然而，41例黏膜下癌患者中，15例有淋巴侵犯（37%），13例有静脉侵犯（32%），2例有淋巴结转移（5%）。撰写本文时，83例患者存活且无复发迹象（中位随访62个月，范围12 - 136个月）。1例产生甲胎蛋白的肿瘤患者在胃次全切除术后23个月死于肝转移。9例患者发生第二原发性癌症，6例死于第二原发性癌症且无早期胃癌复发迹象。总体5年和10年生存率分别为82%和66%，85例患者相应的疾病特异性生存率均为98%。
即使在非专科中心，早期胃癌的治疗也能取得优异的长期结果。早期胃癌患者在胃癌治疗前后均应检测甲胎蛋白浓度，并检查是否存在其他恶性疾病。
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