Park Seong-Heum, Kim Jong-Han, Park Joong-Min, Park Sung-Soo, Kim Seung-Joo, Kim Chong-Suk, Mok Young-Jae
Department of Surgery, Korea University College of Medicine, 1, 5-Ga, Anam-dong, Sungbuk-gu, Seoul, 136-701, Korea.
World J Surg. 2009 Feb;33(2):303-11. doi: 10.1007/s00268-008-9829-9.
The value of nonpalliative resection in metastatic gastric cancer has not been clearly defined.
The survival and incidence of subsequent palliative interventions in 72 patients with metastatic gastric cancer who underwent nonpalliative resection were retrospectively compared with those of 56 patients that did not undergo resection.
The median survival of patients who underwent resection was greater than that of patients who did not (12.0 months versus 4.8 months; p = 0.000). However, more patients in the resection group had a good performance status, no neighboring organ invasion, and only one metastatic site, and this might have caused the survival difference. Adjuvant chemotherapy was the only independent predictor of survival after resection. Incidences of subsequent palliative procedures were not significantly different in the two study groups (43.1% in resection group versus 39.3% in the nonresection group; p = 0.668). However, the mean interval between operation and the first procedure was significantly different in the two groups (287.3 days in the resection group versus 164.1 days in the nonresection group; p = 0.032).
The survival of the patients that underwent nonpalliative resection was poor, and nonpalliative gastrectomy did not decrease requirements for subsequent palliative procedures. Only a few patients with a favorable response to adjuvant chemotherapy survived longer after resection and benefited from a longer symptom-free period until the subsequent palliative procedures were required. Nonpalliative resection should be reserved for selected patients based on performance status, resection feasibilities and metastatic tumor loads, and adjuvant chemotherapy should be combined as part of multimodality therapy.
转移性胃癌非姑息性切除术的价值尚未明确界定。
对72例行非姑息性切除术的转移性胃癌患者的生存情况及后续姑息性干预的发生率进行回顾性分析，并与56例未行切除术的患者进行比较。
接受切除术患者的中位生存期长于未接受切除术的患者（12.0个月对4.8个月；p = 0.000）。然而，切除组中更多患者的体能状态良好、无邻近器官侵犯且仅有一个转移部位，这可能导致了生存差异。辅助化疗是切除术后生存的唯一独立预测因素。两个研究组后续姑息性治疗的发生率无显著差异（切除组为43.1%，未切除组为39.3%；p = 0.668）。然而，两组手术与首次姑息性治疗之间的平均间隔时间有显著差异（切除组为287.3天，未切除组为164.1天；p = 0.032）。
接受非姑息性切除术患者的生存情况较差，非姑息性胃切除术并未降低后续姑息性治疗的需求。只有少数对辅助化疗反应良好的患者在切除术后生存期延长，并在需要后续姑息性治疗之前受益于更长时间的无症状期。非姑息性切除术应根据体能状态、切除可行性和转移瘤负荷等因素，选择合适的患者进行，并且应将辅助化疗作为多模式治疗的一部分联合应用。
