Department of Surgery, Hanyang University College of Medicine, Seoul, Korea.
J Gastric Cancer. 2011 Mar;11(1):46-54. doi: 10.5230/jgc.2011.11.1.46. Epub 2011 Mar 31.
There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence.
From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group).
Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes.
The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.
针对胃癌胃切除术后复发的预测因素，目前仅有少数研究予以关注。本研究分析了死于复发性胃癌的患者，并试图阐明与复发时间相关的临床病理因素。
自 1992 年 6 月至 2009 年 3 月，汉阳明信大学医学院外科共对 1795 例患者进行了根治性胃切除术。其中 428 例患者死亡，在这些死于复发性胃癌的患者中，共有 311 例被纳入本研究。比较了根治性胃切除术后 1 年内（早期复发组）和 3 年后（晚期复发组）死亡的 72 例和 92 例患者的临床病理发现。
与晚期复发组相比，早期复发组年龄更大，分期更晚，肿瘤分化程度更低，且更倾向于出现淋巴管浸润、血管浸润和神经周围浸润。特别是在分期更晚（Ⅲ期和Ⅳ期）的胃癌患者中，早期复发组术前血清癌胚抗原水平、神经周围浸润和清扫淋巴结数量相对较少的比例更高。
根据疾病分期，复发性胃癌的临床病理特征存在显著差异，甚至在同一分期也是如此。为了在根治性手术后尽早发现复发，重要的是要认识到预示复发高风险的临床病理因素。根据临床病理因素制定个体化的监测计划是强制性的。
