[残胃癌的外科治疗与预后]

Zhou Li-Xin, Zhang Ze-Wei, Xu Zhi-Yuan

Department of Hepatobiliary Pancreatic and Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.

Ai Zheng. 2009 May;28(5):511-4.

BACKGROUND AND OBJECTIVE

Gastric stump cancer (GSC) has unique biological behaviors and poor prognosis. The surgical treatment for GSC is complex. This study was to explore the clinical characteristics of GSC and the effect of operation patterns on long-term survival, and investigate its prognostic factors.

METHODS

The clinical data of 81 GSC patients, treated in Zhejiang Cancer Hospital from January 1990 to December 2007, were analyzed. Patients' survival was analyzed by Kaplan-Meier method; the prognosis was analyzed by Cox multivariate regression model.

RESULTS

Of the 81 patients, 47 (58.0%) received radical resection, 34 received non-radical operation (including palliative operation, short circuit or fistulation and exploration). The overall 1-, 3-, and 5-year survival rates were 69.1%, 24.3%, and 11.8% in the whole group. The 1-, 3-, and 5-year survival rates were significantly higher in radical resection group than in non-radical operation group (93.6% vs. 35.3%, 42.0% vs. 5.9%, 20.8% vs. 0, P<0.05). Cox multivariate regression analysis showed that clinical stage, pathologic classification, radical resection, peritoneal seeding and liver metastasis were related with the survival of GSC patients.

CONCLUSIONS

Radical resection may help to improve the prognosis of GSC. Clinical stage, pathologic classification, radical resection, peritoneal seeding and liver metastasis are independent prognosis factors of GSC.

背景与目的

残胃癌（GSC）具有独特的生物学行为且预后较差。GSC的外科治疗较为复杂。本研究旨在探讨GSC的临床特征以及手术方式对长期生存的影响，并研究其预后因素。

方法

分析1990年1月至2007年12月在浙江省肿瘤医院接受治疗的81例GSC患者的临床资料。采用Kaplan-Meier法分析患者的生存情况；采用Cox多因素回归模型分析预后。

结果

81例患者中，47例（58.0%）接受了根治性切除，34例接受了非根治性手术（包括姑息性手术、短路或造瘘以及探查）。全组患者的1年、3年和5年总生存率分别为69.1%、24.3%和11.8%。根治性切除组的1年、3年和5年生存率显著高于非根治性手术组（93.6%对35.3%，42.0%对5.9%，20.8%对0，P<0.05）。Cox多因素回归分析显示，临床分期、病理分类、根治性切除、腹膜种植和肝转移与GSC患者的生存相关。