Xiong Henry Q, Gunderson Leonard L, Yao James, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, TX 77030, USA.
Lancet Oncol. 2003 Aug;4(8):498-505. doi: 10.1016/s1470-2045(03)01170-7.
The incidence of gastric cancer has been declining in recent years, however, the disease continues to be a worldwide public health problem. About two thirds of patients with gastric cancer undergo surgical resection with curative intent. R0 resection--complete local-regional tumour removal with negative resection margins--is the only curative modality. The optimum extent of lymph-node dissection (D1 vs D2) is controversial. Disease relapse, both local and distant, is common and the 5-year survival rate is disappointing. Adjuvant chemotherapy has been studied extensively in this setting but an effective regimen has not yet been identified. A recent intergroup study has shown that postoperative chemoradiation is effective in improving both disease-free survival (3-year, 48% vs 31%, p<0.001) and overall survival (3-year, 50% vs 41%, p=0.005) compared with surgery alone. Preoperative radiation as a single adjuvant therapy has also yielded improvements in local-regional control, disease-free survival, and overall survival compared with surgery alone. Preoperative chemotherapy or chemoradiation has been accepted to have a theoretical advantage over postoperative therapy and has now been shown to be a feasible option. Its efficacy, however, remains to be tested.
近年来，胃癌的发病率一直在下降，然而，这种疾病仍然是一个全球性的公共卫生问题。约三分之二的胃癌患者接受了旨在治愈的手术切除。R0切除——完整切除局部区域肿瘤且切缘阴性——是唯一的治愈方式。淋巴结清扫的最佳范围（D1与D2）存在争议。局部和远处的疾病复发都很常见，5年生存率令人失望。在这种情况下，辅助化疗已得到广泛研究，但尚未确定有效的方案。最近一项组间研究表明，与单纯手术相比，术后放化疗在提高无病生存率（3年，48%对31%，p<0.001）和总生存率（3年，50%对41%，p=0.005）方面均有效。与单纯手术相比，术前放疗作为单一辅助治疗在局部区域控制、无病生存率和总生存率方面也有改善。术前化疗或放化疗在理论上比术后治疗更具优势，现已证明是一种可行的选择。然而，其疗效仍有待检验。
