Higuchi Katsuhiko, Koizumi Wasaburo, Tanabe Satoshi, Saigenji Katsunori, Ajani Jaffer A
Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.
Oncology. 2004;66(4):269-74. doi: 10.1159/000078326.
Patients with localized proximal gastric carcinoma (PGC) have a poorer outcome than those with distal gastric carcinoma (DGC) following curative resection. However, it remains uncertain whether the location of the primary tumor influences the effect of chemotherapy in advanced gastric carcinoma.
We assessed 270 eligible patients with unresectable, advanced gastric carcinoma who had received first-line chemotherapy between 1989 and 2001. We defined PGC as carcinoma located in the upper one third, and DGC as carcinoma located in the lower two thirds of the stomach.
Of the 270 patients, 91 (33.7%) had PGC, and 179 (66.3%) had DGC. The response rate of the primary lesion was 58.6% (51/87) in the PGC group and 35.1% (59/168) in the DGC group (p < 0.01). The overall response rate for all sites was 55.6% (50/90) in the PGC group and 39.0% (69/177) in the DGC group (p = 0.01). The median survival time was 318 days in the PGC group and 251 days in the DGC group (p = 0.0336). A multivariate analysis revealed that performance status, extent of disease, and location of the primary lesion were significantly related to survival.
Our data suggest that the response rate and survival time after first-line chemotherapy in advanced gastric carcinoma are better in patients with PGC than in those with DGC.
局限性近端胃癌（PGC）患者在根治性切除术后的预后比远端胃癌（DGC）患者差。然而，原发性肿瘤的位置是否会影响晚期胃癌化疗的效果仍不确定。
我们评估了1989年至2001年间接受一线化疗的270例符合条件的不可切除晚期胃癌患者。我们将PGC定义为位于胃上三分之一的癌，将DGC定义为位于胃下三分之二的癌。
270例患者中，91例（33.7%）患有PGC，179例（66.3%）患有DGC。PGC组原发灶的缓解率为58.6%（51/87），DGC组为35.1%（59/168）（p<0.01）。PGC组所有部位的总缓解率为55.6%（50/90），DGC组为39.0%（69/177）（p = 0.01）。PGC组的中位生存时间为318天，DGC组为251天（p = 0.0336）。多因素分析显示，体能状态、疾病范围和原发灶位置与生存显著相关。
我们的数据表明，晚期胃癌患者中，PGC患者一线化疗后的缓解率和生存时间优于DGC患者。
