Maehara Y, Moriguchi S, Kakeji Y, Orita H, Haraguchi M, Korenaga D, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Surg Gynecol Obstet. 1991 Sep;173(3):223-6.
From 1965 to 1985, 356 of 1,468 patients (24.3 per cent) with carcinoma of the stomach who underwent gastric resection had disease arising from the upper one-third of the stomach. Tumors in the upper one-third of the stomach were larger, and gross appearance of types 3 and 4 was frequent. Serosal invasion was prominent, and the rates of metastases of the lymph nodes and liver were higher in carcinoma in the upper one-third of the stomach compared with carcinoma in other regions of the stomach. Palliative resection was done for 43.8 per cent of the patients. Survival rate for patients with carcinoma in the upper one-third of the stomach was lower than for patients with lesions in other regions of the stomach (p less than 0.01). Multivariate analysis indicated that operative curability, hepatic metastasis, serosal invasion, lymph node metastasis, peritoneal dissemination and tumor size are significant prognostic factors for carcinoma in the upper one-third of the stomach. These events, except for peritoneal dissemination, differed between carcinoma in the upper one-third of the stomach and in other regions of the stomach, and the survival rate for patients with carcinoma of the upper one-third of the stomach was less favorable. Early detection is crucial for improving the survival time of patients with carcinoma in the upper one-third of the stomach. Aggressive postoperative chemotherapy should be considered when noncurative resection is done.
1965年至1985年期间，1468例接受胃切除术的胃癌患者中有356例（24.3%）的病灶位于胃的上三分之一处。胃上三分之一处的肿瘤更大，3型和4型的大体外观较为常见。浆膜侵犯明显，与胃其他区域的癌相比，胃上三分之一处的癌的淋巴结转移和肝转移率更高。43.8%的患者接受了姑息性切除术。胃上三分之一处癌患者的生存率低于胃其他区域有病变的患者（P<0.01）。多因素分析表明，手术可治愈性、肝转移、浆膜侵犯、淋巴结转移、腹膜播散和肿瘤大小是胃上三分之一处癌的重要预后因素。除腹膜播散外，这些情况在胃上三分之一处的癌与胃其他区域的癌之间存在差异，胃上三分之一处癌患者的生存率较差。早期检测对于提高胃上三分之一处癌患者的生存时间至关重要。当进行非根治性切除时，应考虑积极的术后化疗。
