Hanazaki K, Mochizuki Y, Machida T, Yokoyama S, Sodeyama H, Sode Y, Wakabayashi M, Kawamura N, Miyazaki T
Department of Surgery, Nagano Red Cross Hospital, Japan.
Hepatogastroenterology. 1999 Mar-Apr;46(26):1238-43.
BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established.
Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given.
Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months).
Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.
背景/目的：对于进展期胃癌行非根治性胃切除术后的患者，术后化疗延长生存期的确切效果尚未明确。
83例行非根治性胃切除的进展期胃癌患者被分为49例接受术后化疗的患者（化疗组）和34例未接受术后化疗的患者（对照组）。化疗方案如下：单纯口服5-氟尿嘧啶（5-FU）（n = 22）、静脉注射丝裂霉素（MMC）加5-FU（n = 20）、静脉注射甲氨蝶呤（MTX）加5-FU（n = 3）、静脉注射顺铂加5-FU（n = 2）以及肝动脉灌注5-FU加口服5-FU（n = 2）。患者术前均未接受化疗或放疗。
尽管对照组患者的年龄（平均71.9岁）显著高于化疗组（平均66.1岁），但两组间其他临床和病理背景数据并无显著差异。化疗组的1年生存率（71.4%）显著高于对照组（50.0%）。然而，化疗组与对照组的3年和5年生存率并无显著差异，分别为30.6%对32.4%以及24.5%对32.4%。尽管两组间无显著差异，但化疗组术后的中位生存期（20.5个月）长于对照组（16.2个月）。此外，化疗组腹膜播散患者的中位生存期（16.4个月）显著长于对照组（7.7个月）。
术后化疗可能有助于延长无法治愈的进展期胃癌患者的生存期，即使患者存在腹膜播散。然而，术后化疗并未提高长期生存率。可能需要更积极的化疗来改善此类患者的长期预后。
