Department of Human Pathology and Oncology, Section of Surgical Oncology, University of Siena, Siena, Italy.
Br J Surg. 2011 Sep;98(9):1273-83. doi: 10.1002/bjs.7528. Epub 2011 May 10.
The aim of the present multicentre observational study was to evaluate potential changes in clinical and pathological features of patients with gastric cancer (GC) treated in a 15-year interval.
A centralized prospective database including clinical, surgical, pathological and follow-up data from 2822 patients who had resection of a primary GC was analysed. The analysis focused on three periods: 1991-1995 (period 1), 1996-2000 (period 2) and 2001-2005 (period 3). Surgical procedure, pathological classification and follow-up were standardized among centres.
The number of resections decreased from 1024 in period 1 to 955 and 843 in periods 2 and 3 respectively. More advanced stages and a smaller number of intestinal-type tumours of the distal third were observed over time. Five-year survival rates after R0 resection (2320 patients) did not change over time (overall: 56·6 and 51·2 per cent in periods 1 and 3; disease-free: 66·8 and 61·1 per cent respectively). Decreases in survival in more recent years were related particularly to more advanced stage, distal tumours and tumours in women. Multivariable analysis showed a lower probability of overall and disease-free survival in the most recent interval: hazard ratio 1·22 (95 per cent confidence interval 1·06 to 1·40) and 1·29 (1·06 to 1·58) respectively compared with period 1. Recurrent tumours were more frequently peritoneal rather than locoregional.
Overall and disease-free survival rates after R0 resection of GC were unchanged over time.
本项多中心观察性研究的目的是评估在 15 年的时间间隔内接受治疗的胃癌（GC）患者的临床和病理特征的潜在变化。
分析了包含 2822 例原发性 GC 患者的临床、手术、病理和随访数据的集中前瞻性数据库。分析集中在三个时期：1991-1995 年（第 1 期）、1996-2000 年（第 2 期）和 2001-2005 年（第 3 期）。各中心之间规范了手术程序、病理分类和随访。
手术例数从第 1 期的 1024 例减少到第 2 期和第 3 期的 955 例和 843 例。随着时间的推移，观察到更晚期的病例和远端第三部分的肠型肿瘤数量减少。R0 切除术后（2320 例患者）的 5 年生存率没有随时间变化（整体：第 1 期和第 3 期分别为 56.6%和 51.2%；无病：分别为 66.8%和 61.1%）。最近几年生存率下降尤其与更晚期的分期、远端肿瘤和女性肿瘤有关。多变量分析显示，与第 1 期相比，最近间隔期的总生存率和无病生存率的可能性降低：总体危险比为 1.22（95%置信区间 1.06 至 1.40）和 1.29（1.06 至 1.58）。复发性肿瘤更频繁地是腹膜而不是局部区域。
R0 切除 GC 的总生存率和无病生存率随时间保持不变。
