Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
World J Surg. 2011 Nov;35(11):2479-84. doi: 10.1007/s00268-011-1246-9.
The benefit of resection of gastric cancer with locoregional invasion is still under debate. This study aimed to investigate the impact of surgery on patients with gastric cancer with locoregional invasion.
From January 1988 to December 2009, a total of 2,678 patients with gastric cancer underwent surgery at the Department of Surgery, Taipei Veterans General Hospital. Among these patients, 569 and 295 were diagnosed as T4a (serosa invasion without penetration of visceral peritoneum) and T4b (serosa exposure with invasion of adjacent structure), respectively. Invasion type and prognosis were analyzed in patients with gastric cancer who had either curative or palliative resection.
Our results showed that patients with T4a gastric cancer had a better 5-year overall survival than patients with T4b (22.5% vs. 11.5%, P < 0.001). Patients with T4b who had curative resection had a better 5-year overall survival than those with T4b who had palliative resection (13.8% vs. 7.3%, P = 0.001). The prognosis of patients with gastric cancer with pancreas invasion was worse than those with mesocolon invasion, as no patients with pancreas invasion survived more than 5 years. Univariate and multivariate analyses showed that tumor size (P = 0.019), Bormann classification (P < 0.001), stromal reaction (P = 0.001), and nodal involvement (P < 0.001) were independent predictors for overall survival in patients with T4b gastric cancer.
Resection of T4b gastric cancer could be performed with curative intent. Patients with gastric cancer with pancreas invasion had a poorer prognosis than those with mesocolon invasion.
局部侵犯的胃癌行切除术的获益仍存在争议。本研究旨在探讨手术对局部侵犯的胃癌患者的影响。
1988 年 1 月至 2009 年 12 月，台北荣民总医院外科共对 2678 例胃癌患者进行了手术。其中，569 例和 295 例分别被诊断为 T4a（浆膜侵犯而无内脏腹膜穿透）和 T4b（浆膜暴露伴邻近结构侵犯）。分析了行根治性或姑息性切除术的胃癌患者的侵犯类型和预后。
我们的结果表明，T4a 胃癌患者的 5 年总生存率优于 T4b 患者（22.5% vs. 11.5%，P < 0.001）。行根治性切除术的 T4b 患者的 5 年总生存率优于姑息性切除术的 T4b 患者（13.8% vs. 7.3%，P = 0.001）。胰腺侵犯的胃癌患者的预后比结系膜侵犯的患者差，因为没有胰腺侵犯的患者生存时间超过 5 年。单因素和多因素分析显示，肿瘤大小（P = 0.019）、Bormann 分类（P < 0.001）、间质反应（P = 0.001）和淋巴结受累（P < 0.001）是 T4b 胃癌患者总生存的独立预测因素。
T4b 胃癌的切除术可达到根治性目的。胰腺侵犯的胃癌患者的预后比结系膜侵犯的患者差。
