Abe S, Shiraishi M, Nagaoka S, Yoshimura H, Dhar D K, Nakamura T
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Surgery. 1991 May;109(5):582-8.
Prognostic factors of gastric cancer with positive serosal invasion and regional lymph node metastasis were evaluated by multivariate analysis. Sixty-seven patients with the T3N1M0 subgroup of stage IIIA disease were evaluated, in which 34.9 +/- 13.4 nodes were dissected in extended lymph node dissection, and 6.5 +/- 6.2 were metastatic. Routine postoperative systemic chemotherapy with mitomycin C and N1-(2'-tetrahydrofuryl)-5-fluorouracil was administered. With this approach, the 5-year survival rate of stage IIIA disease was 47.6%. By Cox proportional hazards model, diameter of serosal invasion was the only significant determinant of prognosis in the T3N1M0 subgroup. The predicted 5-year survival rate for 24 patients with serosal invasion less than 3.0 cm in diameter was 59.5%, compared with 11.5% for 38 patients with invasion of 3.0 cm or larger in diameter. The number of metastatic nodes and the type of operation (total gastrectomy or less than total gastrectomy) did not affect the prognosis. When gastric cancer has both positive serosal invasion and metastatic regional lymph nodes, the diameter of serosal invasion is the more important factor for predicting prognosis.
通过多因素分析评估了伴有浆膜侵犯阳性和区域淋巴结转移的胃癌的预后因素。对67例IIIA期疾病的T3N1M0亚组患者进行了评估，其中在扩大淋巴结清扫术中清扫了34.9±13.4个淋巴结，有6.5±6.2个发生转移。术后常规给予丝裂霉素C和N1-(2'-四氢呋喃基)-5-氟尿嘧啶进行全身化疗。采用这种方法，IIIA期疾病的5年生存率为47.6%。通过Cox比例风险模型，浆膜侵犯直径是T3N1M0亚组中唯一显著的预后决定因素。24例浆膜侵犯直径小于3.0 cm患者的预测5年生存率为59.5%，而38例侵犯直径为3.0 cm或更大患者的5年生存率为11.5%。转移淋巴结数量和手术类型（全胃切除术或次全胃切除术）不影响预后。当胃癌同时存在浆膜侵犯阳性和区域淋巴结转移时，浆膜侵犯直径是预测预后更重要的因素。
