Department of Surgery, Jagiellonian University Medical College, 40 Kopernika Street, 31-501 Krakow, Poland.
Eur J Surg Oncol. 2012 Jun;38(6):490-6. doi: 10.1016/j.ejso.2012.01.013. Epub 2012 Feb 29.
Metastatic gastric cancer remains a significant problem as the majority of Western patients are diagnosed with disseminated disease and no routine therapeutic regimen is accepted in such cases.
A cohort of 3141 patients with gastric cancer operated between 1990 and 2005 was evaluated using a multicenter data set held by the Polish Gastric Cancer Study Group to determine potential risks and benefits of non-curative gastrectomy for metastatic disease. Additionally, parameters of Quality of Life (QoL) were evaluated prospectively in 140 patients undergoing gastrectomy using the QLQ-C30 questionnaire.
Gastrectomy was carried out in 2258 patients. Distant organ metastases were diagnosed in 951 patients, 415 of which underwent non-curative gastrectomy. The overall mortality rates were significantly higher in patients undergoing non-resectional surgery (10%) than either curative (3%, P < 0.001) or non-curative (4%, P = 0.002) gastrectomy. The overall median survival in patients with metastatic disease was significantly higher for non-curative gastrectomy (10.6 months, 95% confidence interval (CI) 9.3-11.9) than for non-resective operations (4.4 months, 95% CI 4.0 to 4.8, P < 0.001). The hazard ratio of death in patients subject to non-resectional surgery compared to those treated by gastrectomy was 2.923 (95% CI 2.473 to 3.454, P < 0.001). A gradual impairment in QoL parameters was found over 12 months after non-curative resections but changes did not reach statistical significance and individual parameters were similar to gastrectomy without distant metastases.
Non-curative gastrectomy for metastatic gastric cancer is associated with significantly better survival compared to non-resective surgery and does not impair quality of life.
转移性胃癌仍然是一个重大问题，因为大多数西方患者被诊断为播散性疾病，并且在这种情况下没有常规的治疗方案被接受。
使用波兰胃癌研究小组持有的多中心数据集，评估了 1990 年至 2005 年间接受手术的 3141 例胃癌患者，以确定非治愈性胃切除术对转移性疾病的潜在风险和益处。此外，前瞻性评估了 140 例接受胃切除术的患者的生活质量（QoL）参数，使用 QLQ-C30 问卷。
2258 例患者接受了胃切除术。951 例患者诊断出远处器官转移，其中 415 例接受了非治愈性胃切除术。非切除术患者的总死亡率明显高于根治性手术（3%，P < 0.001）或非治愈性手术（4%，P = 0.002）。转移性疾病患者的总体中位生存期，非治愈性胃切除术明显高于非切除术（10.6 个月，95%置信区间[CI] 9.3-11.9）比非切除术（4.4 个月，95% CI 4.0-4.8，P < 0.001）。与接受非切除术的患者相比，接受非切除术的患者死亡的风险比为 2.923（95% CI 2.473-3.454，P < 0.001）。在非治愈性切除术后 12 个月发现 QoL 参数逐渐恶化，但变化未达到统计学意义，并且个别参数与无远处转移的胃切除术相似。
与非切除术相比，转移性胃癌的非治愈性胃切除术与显著改善的生存相关，并且不会损害生活质量。
