Patel Pooja R, Yao James C, Hess Kenneth, Schnirer Isac, Rashid Asif, Ajani Jaffer A
Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2007 Nov 15;110(10):2186-90. doi: 10.1002/cncr.23046.
Patients with advanced gastric cancer have a median survival (MS) of <9 months. It is unclear whether the MS of patients who have advanced cancer at the time of diagnosis (synchronous, Group A) is different from that for patients who develop advanced cancer after curative surgery (metachronous, Group B). It was hypothesized that survival would be similar.
The medical records of all patients treated at the University of Texas M. D. Anderson Cancer Center who were in either Group A or Group B were reviewed. Survival of patients was assessed by the Kaplan-Meier method. A Cox proportional hazards model was used for multivariate hazards ratios that were adjusted for the effects of location of recurrence, histologic differentiation, patient sex and age, the location of the primary tumor, and timing of disease recurrence (Group A or Group B) on survival.
In all, 773 consecutive patients qualified for the analysis. The distribution of age, race, histologic differentiation, and primary tumor location was similar in both groups. The MS of Group A (n = 603 patients) and Group B (n = 170 patients) was the same (7.6 months). Similarly, the location of the primary tumor and patient sex were found to have no impact on survival. Patients with poorly differentiated tumors (World Health Organization grade 3 or 4) were found to have a shorter survival compared with those with well-differentiated or moderately differentiated tumors (grade 1 or 2; P = .004). Patients with distant metastases had a shorter survival (P = .01) than those with locoregional disease recurrence.
The data show that MS is similarly poor in patients with advanced gastric cancer with synchronous metastasis (Group A) or those with metachronous metastasis/disease recurrence (Group B). Poor differentiation and anatomically distant site of metastasis were found to impact MS adversely.
晚期胃癌患者的中位生存期（MS）小于9个月。目前尚不清楚诊断时即患有晚期癌症的患者（同时性，A组）的中位生存期是否与根治性手术后发生晚期癌症的患者（异时性，B组）不同。研究假设两者生存期相似。
回顾了得克萨斯大学MD安德森癌症中心接受治疗的A组或B组所有患者的病历。采用Kaplan-Meier法评估患者的生存期。使用Cox比例风险模型计算多变量风险比，并对复发部位、组织学分化程度、患者性别和年龄、原发肿瘤部位以及疾病复发时间（A组或B组）对生存期的影响进行校正。
共有773例连续患者符合分析条件。两组患者的年龄、种族、组织学分化程度和原发肿瘤部位分布相似。A组（n = 603例患者）和B组（n = 170例患者）的中位生存期相同（7.6个月）。同样，原发肿瘤部位和患者性别对生存期无影响。与高分化或中分化肿瘤（1级或2级）患者相比，低分化肿瘤（世界卫生组织3级或4级）患者的生存期较短（P = 0.004）。远处转移患者的生存期（P = 0.01）比局部区域疾病复发患者短。
数据表明，伴有同时性转移的晚期胃癌患者（A组）或伴有异时性转移/疾病复发的患者（B组）的中位生存期同样较差。低分化和远处转移部位对中位生存期有不利影响。
