Yokota Takashi, Saito Toshihiro, Teshima Shin, Yamada Yasuo, Iwamoto Kazutsugu, Takahashi Michinori, Ishiyama Shuichi, Murata Katsuyuki, Yamauchi Hidemi
Department of Gastroenterological Surgery, Sendai National Hospital, Japan.
Ups J Med Sci. 2002;107(1):17-22. doi: 10.3109/2000-1967-138.
Although many studies have focused on clinical risk factors for prognosis of patients with surgically treated gastric cancer, little information is available regarding the timing of recurrent malignant disease. The purpose of this study was to determine the factors that are predictive of early and late recurrences after gastrectomy.
We reviewed the hospital records of patients with hisotological proof of gastric cancer who were admitted to Sendai National Hospital during the period from 1985 to 1995. A total of 923 records were examined, and 251 patients with recurrent disease were identified. The patients were divided into an "early recurrence group" consisting of 195 patients (died within one year after surgery) and a "late recurrence group" of 56 patients (died two years or more after surgery). Clinicopathological characteristics were examined, and independent risk factors influencing the timing of recurrence were determined by a multiple logistic regression analysis.
The mean tumor size of early recurrence cases was larger than that of late recurrence cases (p=0.0294). Tumors penetrating the serosa with direct invasion to continuous structures were found more frequently in the early recurrence group than in the late recurrence group. The patients with early recurrence showed a higher tendency to have nodal involvement, lymphatic invasion and vascular invasion. The relative risks of early and late recurrences associated with different variables were estimated by a multiple logistic regression method. The following variables were found to be significant risk factors for early recurrence: male gender (p=0.0382), lymph node metastasis (p=0.0016), and vascular invasion (p=0.0006).
Male patients who have node-positive gastric cancer with vascular invasion have a high risk of early recurrence.
尽管许多研究聚焦于手术治疗胃癌患者预后的临床危险因素，但关于复发性恶性疾病发生时间的信息却很少。本研究的目的是确定胃切除术后早期和晚期复发的预测因素。
我们回顾了1985年至1995年期间入住仙台国立医院、经组织学证实为胃癌患者的医院记录。共检查了923份记录，确定了251例复发患者。这些患者被分为“早期复发组”（195例，术后1年内死亡）和“晚期复发组”（56例，术后2年或更长时间死亡）。对临床病理特征进行了检查，并通过多因素逻辑回归分析确定影响复发时间的独立危险因素。
早期复发病例的平均肿瘤大小大于晚期复发病例（p = 0.0294）。早期复发组中肿瘤穿透浆膜并直接侵犯连续结构的情况比晚期复发组更常见。早期复发患者在淋巴结受累、淋巴管侵犯和血管侵犯方面表现出更高的倾向。通过多因素逻辑回归方法估计了与不同变量相关的早期和晚期复发的相对风险。发现以下变量是早期复发的显著危险因素：男性（p = 0.0382）、淋巴结转移（p = 0.0016）和血管侵犯（p = 0.0006）。
患有伴有血管侵犯的淋巴结阳性胃癌的男性患者早期复发风险高。
