Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Gastrointest Surg. 2010 Feb;14(2):282-8. doi: 10.1007/s11605-009-1095-0. Epub 2009 Nov 25.
The prognosis for gastric cancer patients with distant metastasis is very poor. The purpose of this study was to evaluate the survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis.
From 1992 to 2002, 253 gastric cancer patients with synchronous distant metastasis underwent surgery at the Department of Surgery, Ruijin Hospital, China. The clinicopathological characteristics and survival were compared between resection and non-resection groups.
The 5-year survival rate was 6.5% for patients in resection group and 0% for patients in non-resection group (P < 0.001). Multivariate analysis showed that liver metastasis, peritoneal dissemination, and non-resection were significantly associated with poor prognosis in gastric cancer patients with distant metastasis. The survival difference between resection and non-resection groups was only observed in patients with single peritoneal dissemination (P < 0.001), but were not in patients with single liver metastasis (P = 0.428), distant nodes involvement (P = 0.490) and multiple metastatic sites (P = 0.192), respectively.
Our results suggests that there were no survival benefit from non-curative gastrectomy for patients with single liver, distant nodes, or multiple sites metastasis. However, only patients with single peritoneal dissemination had survival benefit from non-curative resection. The value of non-curative resection should be evaluated by well-designed clinical trials.
患有远处转移的胃癌患者预后非常差。本研究旨在评估非治愈性胃切除术对患有同步远处转移的胃癌患者的生存获益。
1992 年至 2002 年，外科手术部的 253 名患有同步远处转移的胃癌患者接受了手术。比较了切除组和非切除组之间的临床病理特征和生存情况。
切除组的 5 年生存率为 6.5%，而非切除组为 0%（P<0.001）。多因素分析表明，肝转移、腹膜播散和非切除术与远处转移的胃癌患者预后不良显著相关。仅在患有单个腹膜播散的患者中观察到切除组和非切除组之间的生存差异（P<0.001），但在患有单个肝转移的患者中（P=0.428）、远处淋巴结受累的患者（P=0.490）和多个转移部位的患者（P=0.192）中则没有观察到这种差异。
我们的结果表明，对于患有单个肝、远处淋巴结或多个部位转移的患者，非治愈性胃切除术没有生存获益。然而，只有患有单个腹膜播散的患者才能从非治愈性切除中获得生存获益。非治愈性切除的价值应通过精心设计的临床试验来评估。
