IV 期胃癌（IVA、IVB 和 IVC）的亚分类和亚分期的预后意义。
Subclassification of stage IV gastric cancer (IVa, IVb, and IVc) and prognostic significance of substages.
机构信息
Department of Gastroenterology, Tumor Hospital of Harbin Medical University, Helongjiang, China.
出版信息
J Gastrointest Surg. 2010 Mar;14(3):484-92. doi: 10.1007/s11605-009-1110-5. Epub 2009 Dec 1.
BACKGROUND
Although the prognosis of stage IV gastric cancer is poor, some patients with stage IV gastric cancer had a long-term survival after gastrectomy. The objective of this study was to subclassify stage IV gastric cancer according to survival differences, evaluate the prognosis by substage, and identify the factors associated with patient survival in each substage.
METHODS
The data from 1,176 patients who underwent gastric resection for stage IV gastric cancer between 1988 and 2007 at Tumor Hospital of Harbin Medical University were reviewed retrospectively. The patients were divided into three substages according to the survival differences: stage IVa (T1-2N3M0), stage IVb (T3N3M0 and T4N1-2M0), and stage IVc (T4N3M0 and TanyNanyM1). The clinicopathological characteristics as well as survival of the patients were evaluated retrospectively by substage.
RESULTS
There were no significant differences in survival among T3N3M0, T4N1M0, and T4N2M0 groups (p = 0.884) and between T4N3M0 and TanyNanyM1 groups (p = 0.192). The 5-year survival rates in stage IVa (T1-2N3M0), stage IVb (T3N3M0 and T4N1-2M0), and stage IVc (T4N3M0 and TanyNanyM1) were 22.7%, 9.9%, and 2.2%, respectively (p < 0.001). Multivariate analysis showed the following independent prognostic factors for survival: subclassification, operation type, number of retrieved lymph nodes, curability, and chemotherapy for stage IV gastric cancer; curability, chemotherapy, and number of retrieved lymph nodes for stage IVa and IVb; chemotherapy and operation type for stage IVc. For 406 patients with curative resection in stage IVa and IVb, hematogenous recurrence (35.9%) was the dominant recurrence pattern in stage IVa, whereas the most common patterns of recurrence were peritoneal (40.8%) and locoregional recurrence (31.8%) in stage IVb.
CONCLUSIONS
Subclassification of stage IV gastric cancer into IVa (T1-2N3M0), IVb (T3N3M0 and T4N1-2M0), and IVc (T4N3M0, TanyNanyM1) may be helpful to predict the outcome and determine the therapeutic strategies for patients with stage IV gastric cancer.
背景
尽管 IV 期胃癌的预后较差，但部分 IV 期胃癌患者在接受胃切除术后可获得长期生存。本研究旨在根据生存差异对 IV 期胃癌进行亚分类，评估各亚分期的预后，并确定与各亚分期患者生存相关的因素。
方法
回顾性分析 1988 年至 2007 年哈尔滨医科大学肿瘤医院收治的 1176 例行胃切除术的 IV 期胃癌患者的资料。根据生存差异将患者分为三个亚组：IVa 期（T1-2N3M0）、IVb 期（T3N3M0 和 T4N1-2M0）和 IVc 期（T4N3M0 和 TanyNanyM1）。通过亚分期回顾性评估患者的临床病理特征和生存情况。
结果
T3N3M0、T4N1M0 和 T4N2M0 组之间的生存差异无统计学意义（p=0.884），T4N3M0 与 TanyNanyM1 组之间的生存差异亦无统计学意义（p=0.192）。IVa 期（T1-2N3M0）、IVb 期（T3N3M0 和 T4N1-2M0）和 IVc 期（T4N3M0 和 TanyNanyM1）的 5 年生存率分别为 22.7%、9.9%和 2.2%（p<0.001）。多因素分析显示，影响 IV 期胃癌患者生存的独立预后因素包括：亚分类、手术类型、检出淋巴结数量、可切除性和 IV 期胃癌的化疗；IVa 和 IVb 期的可切除性、化疗和检出淋巴结数量；IVc 期的化疗和手术类型。在 406 例可切除的 IVa 和 IVb 期患者中，血行复发（35.9%）是 IVa 期的主要复发模式，而腹膜复发（40.8%）和局部区域复发（31.8%）是 IVb 期最常见的复发模式。
结论
将 IV 期胃癌分为 IVa（T1-2N3M0）、IVb（T3N3M0 和 T4N1-2M0）和 IVc（T4N3M0、TanyNanyM1）可能有助于预测 IV 期胃癌患者的结局，并确定其治疗策略。
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