Moriguchi S, Maehara Y, Korenaga D, Sugimachi K, Nose Y
Department of Medical Informatics, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Surg Oncol. 1992 Oct;1(5):341-6. doi: 10.1016/0960-7404(92)90034-i.
The objective of the study was to define risk factors for peritoneal dissemination and haematogenous metastasis after curative resection of patients with an advanced gastric cancer. In retrospective analyses of 405 patients, 168 died of a tumour recurrence. Patients who died of gastric cancer were more likely to have large, invasive tumours which had spread throughout the stomach, metastasized to lymph nodes, and vessel invasion by gastric cancerous cells (P < 0.01 or P < 0.05). Of the 168 deaths, 60 (35.7%) were secondary to haematogenous recurrence, 53 (31.5%) were related to peritoneal dissemination, and 19 (11.3%) were related to a local recurrence. To determine the independent risk factors related to peritoneal dissemination and haematogenous metastasis, multivariate analyses using a stepwise logistic model suggested that serosal invasion (P < 0.01, relative risk = 2.57) and Borrmann type 4 (P < 0.01, relative risk = 1.95) were the greatest risk factors for peritoneal dissemination. The presence of lymph node metastasis (P < 0.01, relative risk = 2.62) and presence of vessel invasion by cancerous cells (P < 0.05, relative risk = 1.59) were the greatest risk factors for a haematogenous metastasis.
本研究的目的是确定进展期胃癌患者根治性切除术后腹膜播散和血行转移的危险因素。在对405例患者的回顾性分析中，168例死于肿瘤复发。死于胃癌的患者更有可能患有体积大、具有侵袭性的肿瘤，这些肿瘤已扩散至全胃、转移至淋巴结且存在胃癌细胞的血管侵犯（P<0.01或P<0.05）。在这168例死亡病例中，60例（35.7%）继发于血行复发，53例（31.5%）与腹膜播散有关，19例（11.3%）与局部复发有关。为了确定与腹膜播散和血行转移相关的独立危险因素，使用逐步逻辑模型进行的多因素分析表明，浆膜侵犯（P<0.01，相对风险=2.57）和Borrmann 4型（P<0.01，相对风险=1.95）是腹膜播散的最大危险因素。淋巴结转移的存在（P<0.01，相对风险=2.62）和癌细胞血管侵犯的存在（P<0.05，相对风险=1.59）是血行转移的最大危险因素。
