Schafmayer C, Jürgens G, Jürgens I, Klomp H-J, Fändrich F, Kahlke V
Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7.
Zentralbl Chir. 2007 Dec;132(6):515-22. doi: 10.1055/s-2007-981373.
Despite advances in operative technique long-term survival of curatively operated gastric cancer patients still remains poor with 5-year-survival of 25 %. Gender differences have been recognized in patients with colorectal carcinoma with a higher 5-year-survival of women. The long time-survival of the individual patient is closely dependent on his immunofunction. If a splenectomy has to be carried out, the postoperative immunofunction will be affected considerably. Thus, the question arises as to how far gender and splenectomy influence the long time-survival after curative gastric cancer surgery.
In a retrospective analysis of 505 patients with gastric cancer who had been treated between the years 1992 and 2002, a curative resection, i. e. R0, could be performed in 243 patients (48.1 %) with a definite classified tumour stadium according to the UICC (1997). The sociodemographic, operative, histomorphologic and postoperative data of each patient were collected, stratified by gender and compared using log-rank-test (survival) and chi-square-test (distribution). Multivariate analysis was performed by cox regression. The level of significance was set at p < 0.05.
The sociodemographic, histopathologic and operative data between the two genders were comparable. The morbidity between men and women was not significant. However the rate of postoperative sepsis was higher in men (p < 0.05). With regard to the long-term survival, no difference could be shown between the two groups. However, splenectomy had a significant effect on long time-survival. Women with preserved spleen had a significantly improved five-year-survival rate as compared to women undergoing splencetomy and men with preserved spleen (p < 0.05). Multivariate analysis revealed only the tumour stage as a predictor for long time-survival in men, whereas in women the extend of lymphadenectomy and sepsis also influenced long time-survival.
Long time-survival of curatively operated gastric cancer patients is gender dependent in terms of splenectomy. Therefore, gender differences should be taken into account in analysing long-term data of oncological patients.
尽管手术技术有所进步，但接受根治性手术的胃癌患者长期生存率仍然很低，5年生存率仅为25%。在结直肠癌患者中已认识到存在性别差异，女性的5年生存率更高。个体患者的长期生存很大程度上取决于其免疫功能。如果必须进行脾切除术，术后免疫功能将受到相当大的影响。因此，出现了性别和脾切除术对胃癌根治术后长期生存影响程度的问题。
对1992年至2002年间接受治疗的505例胃癌患者进行回顾性分析，其中243例（48.1%）患者根据UICC（1997）标准进行了根治性切除（即R0），肿瘤分期明确。收集每位患者的社会人口统计学、手术、组织形态学和术后数据，按性别分层，并使用对数秩检验（生存率）和卡方检验（分布）进行比较。通过cox回归进行多变量分析。显著性水平设定为p<0.05。
两性之间的社会人口统计学、组织病理学和手术数据具有可比性。男性和女性的发病率无显著差异。然而，男性术后败血症发生率较高（p<0.05）。关于长期生存，两组之间未显示出差异。然而，脾切除术对长期生存有显著影响。与接受脾切除术的女性和保留脾脏的男性相比，保留脾脏的女性5年生存率显著提高（p<0.05）。多变量分析显示，仅肿瘤分期是男性长期生存的预测因素，而在女性中，淋巴结清扫范围和败血症也影响长期生存。
在脾切除术方面，接受根治性手术的胃癌患者的长期生存存在性别差异。因此，在分析肿瘤患者的长期数据时应考虑性别差异。
