Kurita Nobuhiro, Shimada Mitsuo, Utsunomiya Tohru, Iwata Takashi, Nishioka Masanori, Yoshikawa Kozo, Miyatani Tomohiko, Higashijima Jun, Nakao Toshihiro
Department of Surgery, The University of Tokushima, 770-8503 Kuramoto-cho 3-18-15, Tokushima, Japan.
Hepatogastroenterology. 2010 Jul-Aug;57(101):980-3.
Preoperative radiological diagnosis of gastric cancer with peritoneal metastasis is still incomplete. Staging laparoscopy is performed for patients who are diagnosed T3 or T4 preoperatively. The aim of this study is to establish a method for predicting peritoneal metastasis.
236 gastric cancer patients who were determined histologically at the final staging were studied. We evaluated whether the parameters of preoperative evaluation such as maximum tumor size, circumferential involvement, macroscopic type, number of metastatic lymph nodes and histological differentiation could predict a peritoneal metastasis.
The patients with maximum tumor size > 50 mm in diameter, all 4 cross-sectional parts in circumference involved, Type IV tumor, number of metastatic lymph nodes > 3 and histologically undifferentiated type had a significantly higher incidence of peritoneal metastasis, compared with those with other types. Maximum tumor size > 50 mm, all 4 cross-sectional parts involved and type IV were confirmed as independent risk factors by multivariate analysis. A predictive equation "y = 0.018+0.171 (Maximum tumor size > 50 mm)+0.387 (all 4 cross-sectional parts involved)+0.183 (type IV)" was established. When y value was set to 0.5, sensitivity and specificity were 78.3%, 88.5%, respectively.
The predictive equation of peritoneal metastasis revealed satisfactory results and can be regarded as useful in diagnosing peritoneal metastasis.
术前对伴有腹膜转移的胃癌进行放射学诊断仍不完善。对于术前诊断为T3或T4期的患者需行分期腹腔镜检查。本研究旨在建立一种预测腹膜转移的方法。
对236例经最终分期组织学确诊的胃癌患者进行研究。我们评估术前评估参数，如最大肿瘤大小、环周受累情况、大体类型、转移淋巴结数量和组织学分化程度是否能预测腹膜转移。
与其他类型患者相比，最大肿瘤直径>50mm、环周4个断面均受累、IV型肿瘤、转移淋巴结数量>3且组织学类型为未分化型的患者腹膜转移发生率显著更高。多因素分析证实最大肿瘤大小>50mm、4个断面均受累和IV型为独立危险因素。建立了预测方程“y = 0.018 + 0.171（最大肿瘤大小>50mm）+ 0.387（4个断面均受累）+ 0.183（IV型）”。当y值设定为0.5时，敏感性和特异性分别为78.3%、88.5%。
腹膜转移预测方程显示出满意结果，可用于诊断腹膜转移。
