Yokota T, Kunii Y, Saito T, Teshima S, Narushima Y, Yamada Y, Iwamoto K, Kagami M, Takahashi M, Kikuchi S, Yamauchi H
Department of Surgery, Sendai National Hospital, Japan.
Ups J Med Sci. 2000;105(3):227-34.
Advanced gastric cancer is classified into four Borrmann types, types 1 to 4. Type 4 is a relatively undifferentiated carcinoma with little or no gland-forming capability. Despite recent advances in the diagnosis and surgical management of gastric cancer, most tumors of Borrmann type 4 are not detected at an early stage and the prognosis remains poor; the five-year survival rate after gastric resection ranges from 10 to 20 percent. We evaluated the affects of several clinicopathologic variables on the 5-year survival rate after resection of Borrmann type 4 gastric cancer.
Data on clinical characteristics were obtained from the records of patients who underwent gastric resection between 1985 and 1995 at the Department of Surgery, Sendai National Hospital, and follow-up data were obtained from our tumor registry. Pathologic characteristics were determined from a detailed review of all available histopathologic slides. The relationship between clinicopathologic variables and 5-year survival rate was estimated by the Kaplan-Meier survival curve and the logrank test. Multivariate Cox's proportional hazards regression analysis was then performed to determine which variables were independent prognostic factors.
Eighty-seven patients with Borrmann type 4 gastric cancer underwent a resection during the study period at our hospital. The overall 5-year survival rate was 14.8%. The relationship between clinicopathologic variables and 5-year survival rate was determined by constructing a Kaplan-Meier survival curve. Tumor location (upper, middle and distal vs whole stomach, p=0.0214), lymph node metastasis, capillary microinvasion, and peritonitis carcinomatosa (absent vs present, p<0.05) significantly influenced survival. When multivariate analysis using Cox's proportional hazards regression of 5-year survival was performed, capillary microinvasion, peritonitis carcinomatosa (absent vs present) and tumor location (distal vs whole stomach) emerged as the statistically significant independent prognostic factors associated with long-term survival.
Capillary microinvasion and the presence or absence of peritonitis carcinomatosa are more powerful predictors of 5-year survival than is lymph node metastasis. Patients with gastric cancer of the whole stomach have a poorer prognosis than do those with carcinoma in the antrum of the stomach.
进展期胃癌分为四种Borrmann类型，即1至4型。4型是一种相对未分化的癌，几乎没有或完全没有形成腺体的能力。尽管近年来胃癌的诊断和外科治疗取得了进展，但大多数Borrmann 4型肿瘤在早期未被发现，预后仍然很差；胃切除术后的五年生存率为10%至20%。我们评估了几个临床病理变量对Borrmann 4型胃癌切除术后五年生存率的影响。
临床特征数据来自1985年至1995年在仙台国立医院外科接受胃切除术患者的记录，随访数据来自我们的肿瘤登记处。通过详细审查所有可用的组织病理学切片来确定病理特征。通过Kaplan-Meier生存曲线和对数秩检验估计临床病理变量与五年生存率之间的关系。然后进行多变量Cox比例风险回归分析，以确定哪些变量是独立的预后因素。
在我们医院的研究期间，87例Borrmann 4型胃癌患者接受了切除术。总体五年生存率为14.8%。通过构建Kaplan-Meier生存曲线确定临床病理变量与五年生存率之间的关系。肿瘤位置（上、中、远端与全胃，p = 0.0214）、淋巴结转移、毛细血管微浸润和癌性腹膜炎（无与有，p<0.05）对生存有显著影响。当使用Cox比例风险回归对五年生存率进行多变量分析时，毛细血管微浸润、癌性腹膜炎（无与有）和肿瘤位置（远端与全胃）成为与长期生存相关的具有统计学意义的独立预后因素。
与淋巴结转移相比，毛细血管微浸润和癌性腹膜炎的有无是五年生存更有力的预测指标。全胃癌患者的预后比胃窦癌患者差。
