Breaux J R, Bringaze W, Chappuis C, Cohn I
Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112-2822.
World J Surg. 1990 Sep-Oct;14(5):580-6. doi: 10.1007/BF01658794.
The records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35-year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease. The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period. The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5-year survival. There are fewer lesions of the antrum today, but the highest number of 5-year survivors had antral lesions. Long-term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade. For the last 2 decades, patients with stage III and IV lesions comprised one-half of the 5-year survivors. Our overall 5-year survival was 7.9%, but in the last decade it was 8.9%. Our 5-year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.
回顾慈善医院35年间收治的1710例胃腺癌患者的病历，以发现有助于理解该病发病率下降和预后不良的任何趋势。胃癌患者的年发病率已从20世纪50年代的234/10万降至60年代的195/10万，在过去十年中降至108/10万。受影响的白人男性比例下降速度与黑人女性患者频率增加速度相同，而黑人男性和白人女性的比例保持不变。在研究期间，中位年龄从61.5岁升至66岁。可手术率从82.4%降至72.8%，切除率为49%。胃次全切除术是最常见的手术方式，但根治性胃次全切除术的5年生存率最高。如今胃窦部病变较少，但5年生存率最高的是胃窦部病变患者。贲门部病变患者的长期生存率从前25年的零提高到过去十年的14%。在过去20年中，III期和IV期病变患者占5年生存者的一半。我们的总体5年生存率为7.9%，但在过去十年中为8.9%。所有接受切除术患者的5年生存率为17.9%，但在过去十年中升至24.8%。这些改善与发病率下降相结合，降低了胃癌的总体死亡率。
