Nakamura K, Kamei T, Ohtomo N, Kinukawa N, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Am J Gastroenterol. 1999 Aug;94(8):2251-5. doi: 10.1111/j.1572-0241.1999.01301.x.
The most important surgical strategy for advanced gastric cancer is its detection at the curative stage. The aim of this study was to characterize the curable intermediate-stage gastric carcinomas.
Of 1120 consecutive patients who underwent gastric resection for primary gastric cancer from 1979 through 1996, 94 patients were histologically diagnosed as having cancer confined to the muscularis propria (mp cancer), analyzed clinicopathologically, and compared with patients with early and serosal cancers.
The operative incidence of mp cancer was around 8% among cases of gastrectomy, and the ratio of mp cancer to advanced cancer began to increase in 1991. Mp cancer was at a statistically intermediate stage, between early and serosal cancers in terms of symptoms, surgical curability (96%), size and histology of the tumor, and the rate of lymph node metastasis (46%). Preoperative assessments of tumor depth were unclear using radiology and endoscopy; however, 35% of 31 cases studied were diagnosed precisely by endoscopic ultrasonography (EUS). Accuracy of lymph node metastasis diagnosis was the same (65%) by preoperative EUS and by surgeon; however, sensitivity of the surgeon's assessment was higher (69% vs 38%) and specificity of EUS was higher (83% vs 39%). The 5-yr survival rate was 85%, which was significantly better than that of serosal cancer and similar to that of early cancer. Patient outcome was not affected by lymph node metastasis or macroscopic type of tumor.
Mp cancer should be considered an intermediate-stage cancer. Surgery with level 2 lymph node dissection should provide a cure rate similar to that for early cancer.
晚期胃癌最重要的手术策略是在可治愈阶段进行检测。本研究的目的是对可治愈的中期胃癌进行特征描述。
在1979年至1996年连续接受原发性胃癌胃切除术的1120例患者中，94例经组织学诊断为癌局限于固有肌层（mp癌），进行临床病理分析，并与早期癌和浆膜癌患者进行比较。
在胃切除病例中，mp癌的手术发生率约为8%，1991年mp癌与进展期癌的比例开始上升。mp癌在症状、手术可治愈性（96%）、肿瘤大小和组织学以及淋巴结转移率（46%）方面处于统计学上的中期，介于早期癌和浆膜癌之间。术前通过放射学和内镜检查对肿瘤深度的评估不明确；然而，在31例研究病例中，35%通过内镜超声检查（EUS）得到准确诊断。术前EUS和外科医生对淋巴结转移诊断的准确率相同（65%）；然而，外科医生评估的敏感性更高（69%对38%），EUS的特异性更高（83%对39%）。5年生存率为85%，显著优于浆膜癌，与早期癌相似。患者的预后不受淋巴结转移或肿瘤大体类型的影响。
mp癌应被视为中期癌。行二级淋巴结清扫术的手术治愈率应与早期癌相似。
