Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, PR China.
J Surg Oncol. 2012 Dec;106(7):862-71. doi: 10.1002/jso.23158. Epub 2012 May 30.
To investigate the significance of palliative gastrectomy for different types of metastatic gastric cancer patients displaying peritoneal dissemination, hepatic metastasis, distant lymph node metastasis occurring locally during late-stage disease, and multi-organ metastases.
We performed a retrospective study of 862 patients who were histologically diagnosed as late-stage gastric cancer who could not undergo radical surgery at the Sun Yat-sen University Cancer Center between January 1993 and December 2008. The follow-up lasted until December 2010. Chi-square tests and Kaplan-Meier methods were employed to compare the adverse events and prognoses.
In the peritoneal dissemination and multi-organ metastases groups, palliative gastrectomy has no survival benefit (P = 0.705, 0.331, respectively). In the patients with distant lymph-node metastases, liver metastasis and locally late-stage gastric cancer patients, palliative gastrectomy was a prognostic factor (P < 0.001, P < 0.001, P = 0.010, respectively). Multivariable analysis demonstrated that palliative gastrectomy was an independent prognostic factor for distant lymph-node metastases, liver metastasis, and local late-stage gastric cancer patients. Palliative gastrectomy combined with hepatectomy proved to be an independent prognostic factor to improve the overall survival of patients with liver metastases who underwent palliative gastrectomy (P = 0.008).
For late-stage gastric cancer patients, palliative gastrectomy should be considered for locally late-stage, distant lymph node metastasis, and resectable liver metastasis patients. Especially among patients with liver metastasis, transfer medicine is essential for potentially curable patients to obtain access to radical surgery to improve the prognosis.
探讨姑息性胃切除术对不同类型转移性胃癌患者腹膜播散、肝转移、局部晚期远处淋巴结转移和多器官转移的意义。
我们对中山大学肿瘤防治中心 1993 年 1 月至 2008 年 12 月期间无法行根治性手术的 862 例组织学诊断为晚期胃癌患者进行了回顾性研究。随访至 2010 年 12 月。采用卡方检验和 Kaplan-Meier 方法比较不良事件和预后。
在腹膜播散和多器官转移组中，姑息性胃切除术无生存获益（P=0.705，0.331）。在远处淋巴结转移、肝转移和局部晚期胃癌患者中，姑息性胃切除术是预后因素（P<0.001，P<0.001，P=0.010）。多变量分析表明，姑息性胃切除术是远处淋巴结转移、肝转移和局部晚期胃癌患者的独立预后因素。姑息性胃切除术联合肝切除术被证明是改善姑息性胃切除术后肝转移患者总体生存率的独立预后因素（P=0.008）。
对于晚期胃癌患者，应考虑对局部晚期、远处淋巴结转移和可切除肝转移患者行姑息性胃切除术。特别是在肝转移患者中，转移药物对于有根治性手术机会的潜在可治愈患者非常重要，可改善预后。
