Chen J-H, Wu C-W, Lo S-S, Li A F-Y, Hsieh M-C, Shen K-H, Lui W-Y
Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Section 2, Shih-Pai Rd., 201, Taipei 11217, Taiwan.
Eur J Surg Oncol. 2007 Jun;33(5):556-60. doi: 10.1016/j.ejso.2007.01.020. Epub 2007 Feb 27.
Pyloric stenosis usually presents with symptoms, and this may lead patients to consult their physician. We evaluate whether distal gastric cancer patients with pyloric stenosis had a better outcome than those without.
A total of 551 distal gastric cancer patients who received curative subtotal gastrectomy between January 1988 and December 2003 at Taipei Veterans General Hospital were analyzed. Among them, 174 patients were sorted into the pyloric stenosis group according to obstructive symptoms. Their clinicopathological features, survival and prognostic factors were evaluated.
The 5-year overall and disease-free survival rate of distal third gastric adenocarcinoma for the pyloric stenosis group was significantly lower than those without pyloric stenosis. Multivariate analysis revealed the pyloric stenosis group had deeper cancer invasion (relative to pT1, RR of pT2 3.1, p=0.009; pT3 6.1, p<0.001; pT4 16.5, p<0.001), and more lymph node metastasis (RR 3.6; p=0.001). The pyloric stenosis group had a tendency to lymph node metastasis toward the hepatoduodenal ligament, but this did not reach statistical difference. However, the pyloric stenosis group had significantly higher lymph node metastasis in the retropancreatic region (5.17% vs. 0.53%; p=0.001).
Distal gastric cancers with pyloric stenosis have worse biological behavior than those without, and consequently have a poor outcome.
幽门狭窄通常伴有症状，这可能促使患者就医。我们评估患有幽门狭窄的远端胃癌患者是否比未患幽门狭窄的患者预后更好。
对1988年1月至2003年12月在台北荣民总医院接受根治性胃大部切除术的551例远端胃癌患者进行分析。其中，174例患者根据梗阻症状被归入幽门狭窄组。评估他们的临床病理特征、生存率和预后因素。
幽门狭窄组远端三分之一胃癌的5年总生存率和无病生存率显著低于无幽门狭窄的患者。多因素分析显示，幽门狭窄组癌浸润更深（相对于pT1，pT2的相对风险为3.1，p = 0.009；pT3为6.1，p < 0.001；pT4为16.5，p < 0.001），且淋巴结转移更多（相对风险为3.6；p = 0.001）。幽门狭窄组有向肝十二指肠韧带淋巴结转移的趋势，但未达到统计学差异。然而，幽门狭窄组在胰后区域的淋巴结转移显著更高（5.17%对0.53%；p = 0.001）。
伴有幽门狭窄的远端胃癌比不伴有幽门狭窄者具有更差的生物学行为，因此预后不良。
