Rohatgi Pooja R, Yao James C, Hess Kenneth, Schnirer Isac, Rashid Asif, Mansfield Paul F, Pisters Peter W, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2006 Dec 1;107(11):2576-80. doi: 10.1002/cncr.22317.
The effect of the location of disease recurrence after curative (R0) gastrectomy on patient survival has not been elucidated. The authors hypothesized that the location of recurrence would have a significant influence on survival.
Medical records of all patients who received treatment for gastric cancer at The University of Texas M. D. Anderson Cancer Center between 1985 and 1998 were reviewed. Patients who underwent R0 resection for gastric cancer and subsequently developed localized (anastomotic) recurrence (LR), lymph node (regional) recurrence (NR), or distant metastases (DM) were analyzed for overall survival (OS). All study factors were entered into a Cox proportional hazards model to provide multivariate hazard ratios. The model was adjusted for the effects of primary site of recurrence, histologic grade, patient age, and location of the primary tumor.
This retrospective analysis included 227 consecutive patients. The median survival of patients who developed NR (11 months) was similar to that of patients who developed LR (10 months), but both groups had significantly longer median survival compared with patients who developed DM (7 months; log-rank P = .03). Patients who had well differentiated or moderately differentiated tumors had a longer OS (11 months) than patients who had poorly differentiated tumors (8 months; log-rank P = .02). In this cohort, location of the primary cancer and age at recurrence had no significant impact on OS.
The data from this study suggested that, among patients who undergo R0 gastrectomy for gastric cancer, LR and NR versus DM should be considered a valid stratification factor for randomized trials based on significant differences in survival. Determining whether this stratification should apply to histologic differentiation will require further investigation in a larger multicenter cohort.
根治性（R0）胃切除术后疾病复发部位对患者生存的影响尚未阐明。作者推测复发部位会对生存产生重大影响。
回顾了1985年至1998年间在德克萨斯大学MD安德森癌症中心接受胃癌治疗的所有患者的病历。对接受胃癌R0切除并随后出现局部（吻合口）复发（LR）、淋巴结（区域）复发（NR）或远处转移（DM）的患者进行总生存期（OS）分析。将所有研究因素纳入Cox比例风险模型以提供多变量风险比。该模型针对复发原发部位、组织学分级、患者年龄和原发肿瘤位置的影响进行了调整。
这项回顾性分析纳入了227例连续患者。出现NR的患者的中位生存期（11个月）与出现LR的患者相似（10个月），但与出现DM的患者相比，两组的中位生存期均显著更长（7个月；对数秩检验P = 0.03）。肿瘤分化良好或中等分化的患者的OS（11个月）比低分化肿瘤患者更长（8个月；对数秩检验P = 0.02）。在该队列中，原发癌位置和复发时年龄对OS无显著影响。
本研究数据表明，在接受胃癌R0胃切除的患者中，基于生存的显著差异，LR和NR与DM相比应被视为随机试验的有效分层因素。确定这种分层是否应适用于组织学分化需要在更大的多中心队列中进一步研究。
