Lo Su-Shun, Wu Chew-Wun, Chen Jen-Hao, Li Anna Fen-Yau, Hsieh Mao-Chie, Shen King-Han, Lin Hwai-Jeng, Lui Win-Yiu
Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming University, No. 201, Section 2, Shih-pai Road, Taipei, Taiwan.
Ann Surg Oncol. 2007 Feb;14(2):340-7. doi: 10.1245/s10434-006-9077-x. Epub 2006 Nov 9.
Prognosis for patients with early gastric cancer after surgical resection is excellent. The 5-year or even 10-year survival is more than 90%. In the present study, we investigated the result of treating early gastric cancer surgically in our hospital, with special reference to the risk factor(s) for tumor recurrence and the relationship between age and survival.
From January 1988 to December 2002, a total of 479 patients with early gastric cancer underwent resection by our surgeons. Results of preoperative studies, operative findings, histopathology and postoperative follow-up were recorded respectively, and the postoperative disease-related survival, overall survival, tumor recurrence and recurrent patterns were analyzed. The clinicopathological factors were also analyzed to identify the risk factor(s) related to tumor recurrence.
Older patients (>75 years old) had a poorer overall survival than younger patients. However, the disease-related survival was not significantly different between the two. Recurrence was observed in 21 patients, the most important factor of which was lymph node status. Lymph node metastases occurred in 54 patients (11.3%)-coming from mucosal tumors in 12 patients (4.4%) and from submucosal tumors in 42 (20.3%). When the size of the mucosal tumor was smaller than 1 cm, no lymph node metastasis was found in our patients.
The most important risk factor of recurrence in early gastric cancer is lymph node status. Given the low probability of lymph node metastasis and recurrence in tumors less than 1 cm in diameter limited to the mucosa, more limited surgery maybe appropriate in these carefully selected instances.
早期胃癌患者手术切除后的预后良好。5年甚至10年生存率超过90%。在本研究中，我们调查了我院早期胃癌手术治疗的结果，特别关注肿瘤复发的危险因素以及年龄与生存率的关系。
1988年1月至2002年12月，共有479例早期胃癌患者接受了我院外科医生的手术切除。分别记录术前检查结果、手术发现、组织病理学和术后随访情况，并分析术后疾病相关生存率、总生存率、肿瘤复发情况及复发模式。还对临床病理因素进行分析，以确定与肿瘤复发相关的危险因素。
老年患者（>75岁）的总生存率低于年轻患者。然而，两者的疾病相关生存率无显著差异。21例患者出现复发，其中最重要的因素是淋巴结状态。54例患者（11.3%）发生淋巴结转移——12例（4.4%）来自黏膜肿瘤，42例（20.3%）来自黏膜下肿瘤。当黏膜肿瘤大小小于1 cm时，我们的患者未发现淋巴结转移。
早期胃癌复发的最重要危险因素是淋巴结状态。鉴于直径小于1 cm且局限于黏膜的肿瘤发生淋巴结转移和复发的概率较低，在这些经过精心挑选的病例中，更有限的手术可能是合适的。
