胃癌根治性胃切除术后的复发模式：预后因素及对术后辅助治疗的意义

Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy.

作者信息

Schwarz Roderich E, Zagala-Nevarez Kathryn

机构信息

Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California, USA.

出版信息

Ann Surg Oncol. 2002 May;9(4):394-400. doi: 10.1007/BF02573875.

DOI:10.1007/BF02573875

PMID:11986192

Abstract

BACKGROUND

A recent Intergroup trial demonstrated a significant survival advantage of postgastrectomy chemoradiation in gastric cancer patients, primarily because of a reduction of a relative locoregional recurrence (LRR) rate exceeding 70% in control patients. Radical gastrectomy with extended lymphadenectomy may reduce LRR, possibly affecting adjuvant treatment strategies.

METHODS

Information on patients undergoing gastrectomy for potentially curable gastric cancer between 1990 and 2000 was reviewed. Patterns of first disease recurrence, survival, and disease-free survival were calculated, and predictors were identified.

RESULTS

Gastrectomies were performed in 73 patients, with R0 resections in 82%. The median lymph node count was 24; positive nodes were found in 64% of patients. The median actuarial survival was 27 months, with a 5-year survival of 37%. Disease recurred in 35 patients (48%) after a median interval of 7 months (range,.5-67). Recurrent disease patterns included distant only (37%), peritoneal only (23%), peritoneal/locoregional (17%), all sites combined (14%), locoregional only (6%), and distant/locoregional (3%). Recurrence predictors were N3 category for distant recurrence (hazard ratio [HR], 10.2; P =.005), T3/4 category for peritoneal recurrence (HR, 4.8; P =.008), peritoneal relapse (HR, 40; P =.002), and a prior abdominal operation for LRR (HR, 3.2; P =.01). N2 disease had a distant failure risk similar to N1 status and an intraperitoneal failure risk similar to an N3 category.

CONCLUSIONS

Isolated LRR of gastric cancer after gastrectomy and extended lymphadenectomy is rare in this series. Most recurrences appeared diffusely at distant or peritoneal sites, and most LRRs occurred in conjunction with relapse at extraregional sites. Pathologic predictors of intraperitoneal (T3/4) or systemic failure (>N1) could be used to guide individualized, risk-oriented, adjuvant treatment.

摘要

背景

近期一项多组协作试验表明，胃癌患者行胃切除术后进行放化疗有显著的生存优势，这主要是因为对照组患者局部区域复发（LRR）率相对降低超过70%。根治性胃切除加扩大淋巴结清扫术可能降低LRR，这可能会影响辅助治疗策略。

方法

回顾了1990年至2000年间因潜在可治愈性胃癌接受胃切除术患者的信息。计算了首次疾病复发模式、生存率和无病生存率，并确定了预测因素。

结果

73例患者接受了胃切除术，82%为R0切除。中位淋巴结计数为24个；64%的患者发现有阳性淋巴结。中位精算生存率为27个月，5年生存率为37%。35例患者（48%）在中位间隔7个月（范围，0.5 - 67个月）后出现疾病复发。复发疾病模式包括仅远处转移（37%）、仅腹膜转移（23%）、腹膜/局部区域转移（17%）、所有部位联合转移（14%）、仅局部区域转移（6%）以及远处/局部区域转移（3%）。远处复发的预测因素为N3分期（风险比[HR]，10.2；P = 0.005），腹膜复发的预测因素为T3/4分期（HR，4.8；P = 0.008）、腹膜复发（HR，40；P = 0.002）以及既往因LRR接受过腹部手术（HR，3.2；P = 0.01）。N2期疾病的远处转移风险与N1期相似，腹膜转移风险与N3期相似。