Kunisaki Chikara, Shimada Hiroshi, Nomura Masato, Matsuda Goro, Otsuka Yuichi, Ono Hidetaka, Akiyama Hirotoshi
Second Department of Surgery, Yokohama City University School of Medicine 3-9 Fukuura Kanazawa-ku, Yokohama, Japan.
Hepatogastroenterology. 2005 Jan-Feb;52(61):314-8.
BACKGROUND/AIMS: As no appropriate therapeutic strategy has yet been established in scirrhous type gastric cancer, we retrospectively analyzed the therapeutic outcomes in patients with this type of cancer.
A total of 183 patients with scirrhous type gastric cancer were enrolled in the study. 127 of them underwent resection; 61 potentially curative gastrectomy; 66 palliative resection; and 56 had no surgery.
Univariate analysis revealed that the number of metastatic lymph nodes and the depth of invasion influenced prognosis in curatively resected cases, whereas no factor did so after palliative resection. Multivariate analysis showed that prognosis was affected independently by peritoneal metastasis and non-regional lymph node metastasis in all resected cases, but by the number of metastatic lymph nodes in curatively resected cases. There was no significant difference in survival between patients undergoing and those not undergoing palliative gastrectomy. Prophylactic (6) and therapeutic CHPP (12) had no efficacy on peritoneal metastasis. Furthermore, left upper abdominal evisceration (LUAE) (9) did not improve long-term results in curatively resected cases.
In scirrhous type gastric cancer, gastrectomy including extended lymph node dissection is justified only in patients with limited lymph node metastasis, and palliative gastrectomy should be not performed because it has no efficacy on survival.
背景/目的:由于尚未确立针对硬癌型胃癌的合适治疗策略,我们回顾性分析了此类癌症患者的治疗结果。
共有183例硬癌型胃癌患者纳入本研究。其中127例行切除术;61例行潜在根治性胃切除术;66例行姑息性切除术;56例未行手术。
单因素分析显示,在根治性切除病例中,转移淋巴结数量和浸润深度影响预后,而在姑息性切除术后无因素具有此影响。多因素分析表明,在所有切除病例中,腹膜转移和非区域淋巴结转移独立影响预后,但在根治性切除病例中是转移淋巴结数量。接受和未接受姑息性胃切除术的患者生存率无显著差异。预防性(6例)和治疗性CHPP(12例)对腹膜转移无效。此外,左上腹脏器清除术(LUAE)(9例)未改善根治性切除病例中的长期结果。
在硬癌型胃癌中,仅对淋巴结转移有限的患者行包括扩大淋巴结清扫的胃切除术是合理的,不应行姑息性胃切除术,因为其对生存无作用。