Xue Ying-Wei, Wei Yu-Zhe
Department of Gastrointestinal Surgery, The Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150040, PR China.
Chin J Cancer. 2010 Apr;29(4):355-8. doi: 10.5732/cjc.009.10617.
The proportion of stage IV gastric cancer in the whole gastric cancer population in China is still high. This study was to investigate the surgery and pathologic characteristic and prognostic factors of stage IV (M0) gastric cancer.
Clinical data of 630 patients with pathologically confirmed stage IV (M0) gastric cancer treated at the affiliated Tumor Hospital of Harbin Medical University between January 1993 and August 2004 were analyzed using Cox proportional hazard model. Of the 630 patients, 338 received radical excision and 292 received palliative resection.
The overall 1-, 3-, 5-year survival rates were 63.8%, 31.4% and 14.3%, respectively. Univariate analysis showed that Borrmann type, lymphatic metastasis, organ involvement, tumor location, tumor size, pathologic type, radical excision and other organ excision were significant prognostic factors affecting 1-year survival rate (P < 0.05); Borrmann type, lymphatic metastasis, organ involvement, pathologic type and radical excision affected 3-year survival rate (P < 0.05); only organ involvement and pathologic type affected 5-year survival rate (P < 0.05). Multivariate analysis showed that pathologic type was independent prognostic factor for poor survival.
Radical resection and combined organ resection could prolong the survival of stage IV (M0) gastric cancer patients. Chemotherapy, radiotherapy and targeted therapy should be considered for individual therapeutic regimen.
中国IV期胃癌在全部胃癌人群中的占比仍较高。本研究旨在探讨IV期（M0）胃癌的手术及病理特征和预后因素。
采用Cox比例风险模型分析1993年1月至2004年8月在哈尔滨医科大学附属肿瘤医院接受治疗的630例经病理确诊为IV期（M0）胃癌患者的临床资料。630例患者中，338例行根治性切除，292例行姑息性切除。
总体1年、3年、5年生存率分别为63.8%、31.4%和14.3%。单因素分析显示，Borrmann分型、淋巴转移、器官受累、肿瘤部位、肿瘤大小、病理类型、根治性切除及其他器官切除是影响1年生存率的显著预后因素（P<0.05）；Borrmann分型、淋巴转移、器官受累、病理类型及根治性切除影响3年生存率（P<0.05）；仅器官受累和病理类型影响5年生存率（P<0.05）。多因素分析显示，病理类型是生存不良的独立预后因素。
根治性切除及联合器官切除可延长IV期（M0）胃癌患者的生存期。应考虑化疗、放疗及靶向治疗以制定个体化治疗方案。
