Ikeguchi Masahide, Yamamoto Osamu, Kaibara Nobuaki
Faculty of Medicine, Tottori University, Yonago 683-8504, Japan.
In Vivo. 2004 Sep-Oct;18(5):577-80.
The prognosis for patients with scirrhous gastric cancer (SGC) is extremely poor. However, the management protocol for this type of cancer has not been well discussed. In this study, we retrospectively evaluated the management of SGC and we introduced a new treatment protocol for SGC.
Between 1991 and 2001, 58 patients with SGC were treated. Thirty-nine, who underwent gastrectomy, were divided into 3 sub-groups according to peritoneal metastasis (P) and peritoneal washing cytology (CY) status [P(-)/CY(-), P(-)/CY(+), and P(+)/CY(+)]. The survival rates of these 3 sub-groups were compared with patients who did not have a gastrectomy (n=19), retrospectively. From 2002, we started a new treatment protocol for SGC. Laparoscopic diagnosis of P or CY and intraperitoneal chemotherapy (IPC) were performed before performing laparotomy on 10 patients with SGC.
The 5-year survival rate of the 19 patients in P(-)/CY(-) was 11.6%. The survival rates of patients with P(-)/CY(+) or patients with P(+)/CY(+) were no different from patients who did not have gastrectomy (pleural effusion or ascites negative). In 10 patients who were treated with the new protocol, 7 with P(-)/CY(-) underwent gastrectomy after IPC and 3 with P(+)/CY(+) underwent repeated IPC.
Gastrectomy may not have prognostic benefit for patients with SGC with CY(+). Thus, we recommend laparoscopic diagnosis of peritoneal metastasis or peritoneal cytology before performing laparotomy on these patients.
硬癌型胃癌（SGC）患者的预后极差。然而，针对这类癌症的治疗方案尚未得到充分讨论。在本研究中，我们回顾性评估了SGC的治疗情况，并引入了一种新的SGC治疗方案。
1991年至2001年间，58例SGC患者接受了治疗。39例行胃切除术的患者根据腹膜转移（P）和腹腔冲洗细胞学检查（CY）结果分为3个亚组[P（-）/CY（-）、P（-）/CY（+）和P（+）/CY（+）]。回顾性比较这3个亚组与未行胃切除术患者（n = 19）的生存率。从2002年起，我们开始了一种新的SGC治疗方案。对10例SGC患者在开腹手术前行腹腔镜检查以诊断P或CY并进行腹腔内化疗（IPC）。
P（-）/CY（-）组的19例患者5年生存率为11.6%。P（-）/CY（+）组或P（+）/CY（+）组患者的生存率与未行胃切除术（胸腔积液或腹水阴性）的患者无差异。在采用新方案治疗的10例患者中，7例P（-）/CY（-）患者在IPC后行胃切除术，3例P（+）/CY（+）患者接受重复IPC。
对于CY（+）的SGC患者，胃切除术可能对预后无益处。因此，我们建议在对这些患者进行开腹手术前，先进行腹腔镜检查以诊断腹膜转移或腹膜细胞学检查。
