Kodera Y, Yamamura Y, Ito S, Kanemitsu Y, Shimizu Y, Hirai T, Yasui K, Kato T
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Aichi, Japan.
J Surg Oncol. 2001 Nov;78(3):175-81; discussion 181-2. doi: 10.1002/jso.1144.
Borrmann type IV gastric carcinoma (B-4) remains a disease with poor prognosis despite an aggressive surgical approach. Cytology examination of the peritoneal washes is an established prognostic factor for gastric carcinoma in general, and may be useful for identifying adequate treatment strategy for B-4.
Pathologic data from 70 patients with B-4 who underwent laparotomy and peritoneal washing cytology during the recent 6 years were retrieved from a prospective computer database and reviewed. Prognostic significance of the cytology examination along with other known clinicopathologic variables was evaluated by univariate and multivariate analyses.
Long-term survivors were observed only among the patients who were treated with curative R0 resection. Prognosis of the patients with positive cytology and no other residual disease (R1) was extremely poor and was equivalent to that of the patients undergoing noncurative R2 resection. No difference in survival, either, was observed between the patients treated by R2 resection and those who did not undergo resection. Multivariate analysis identified cytology examination as an independent prognostic factor.
Peritoneal washing cytology plays an important role in staging B4. Positive cytology findings as well as other evidence of disseminated disease may indicate that gastrectomy should be avoided.
尽管采取了积极的手术方法，Borrmann IV型胃癌（B-4）仍然是一种预后较差的疾病。一般来说，对腹腔灌洗进行细胞学检查是胃癌的一个既定预后因素，可能有助于确定B-4的适当治疗策略。
从一个前瞻性计算机数据库中检索并回顾了最近6年期间接受剖腹手术和腹腔灌洗细胞学检查的70例B-4患者的病理数据。通过单因素和多因素分析评估细胞学检查以及其他已知临床病理变量的预后意义。
仅在接受根治性R0切除的患者中观察到长期存活者。细胞学检查阳性且无其他残留疾病（R1）的患者预后极差，与接受非根治性R2切除的患者相当。接受R2切除的患者与未接受切除的患者之间在生存率上也未观察到差异。多因素分析确定细胞学检查为独立的预后因素。
腹腔灌洗细胞学检查在B4分期中起重要作用。细胞学检查阳性结果以及其他播散性疾病证据可能表明应避免行胃切除术。
