Department of General Surgery, Turkish Ministry of Health Izmir Bozyaka Research and Training Hospital, Izmir, Turkey.
Digestion. 2012;86(1):67-73. doi: 10.1159/000338298. Epub 2012 Jul 7.
The primary objective of this study was to clarify the influence of histotype on the outcome of D1/D2 gastrectomized patients with pathologically proven R0 resection. The secondary objective was to demonstrate overall survival (OS), disease-free survival (DFS), and locoregional recurrence rates following standard curative surgery.
All patients had either pure signet-ring cell carcinoma (SRCC)/poorly differentiated adenocarcinoma (PDC) or moderately differentiated adenocarcinoma (MDC) of the stomach, preoperative radiologic evidence of locoregional disease, and no history of neoadjuvant therapy. Standards of surgical treatment were essentially based on the guidelines of the Japanese Research Society for the Study of Gastric Cancer.
Between October 2003 and August 2010, seventy-eight patients were enrolled. Twenty-three patients underwent D1 dissection and 55 underwent D2 dissection. The OS and DFS rates were 33.2 ± 5.9 months versus 31.5 ± 4.3 months (p = 0.81) and 28.9 ± 5.6 months vs. 29.3 ± 4.4 months (p = 0.96) in the MDC and SRCC/PDC groups, respectively. Neither the extent of the operation (D1 vs. D2, p = 0.79) nor the histopathologic subtype of the primary tumor (MDC vs. SRCC/PDC, p = 0.91) influenced the OS and DFS. Multivariate logistic regression analysis disclosed pathologic stage (pTNM) as the only significant prognostic determinant of OS (p = 0.007) and DFS (p = 0.0003).
Properly performed D1 and D2 dissection in our series resulted in a notable (6.4%) locoregional failure rate. In spite of the satisfactory locoregional control achieved by D1 and D2, there was no improvement in the survival figures of stage IIIA-B and IV gastric cancer patients. The histopathologic subtype of the primary tumor disclosed merely a statistical trend on the outcome measures of gastric cancer after curative surgery.
本研究的主要目的是阐明组织学类型对病理证实 R0 切除的 D1/D2 胃切除术患者结局的影响。次要目的是展示标准根治性手术后的总生存率（OS）、无病生存率（DFS）和局部区域复发率。
所有患者均患有胃单纯印戒细胞癌（SRCC）/低分化腺癌（PDC）或中分化腺癌（MDC），术前影像学检查显示局部区域疾病，且无新辅助治疗史。手术治疗标准主要基于日本胃癌研究学会的指南。
2003 年 10 月至 2010 年 8 月期间，共纳入 78 例患者。23 例患者行 D1 清扫术，55 例行 D2 清扫术。在 MDC 和 SRCC/PDC 组中，OS 和 DFS 率分别为 33.2±5.9 个月和 31.5±4.3 个月（p=0.81）和 28.9±5.6 个月和 29.3±4.4 个月（p=0.96）。手术范围（D1 与 D2，p=0.79）和原发肿瘤的组织病理学类型（MDC 与 SRCC/PDC，p=0.91）均不影响 OS 和 DFS。多变量逻辑回归分析显示病理分期（pTNM）是 OS（p=0.007）和 DFS（p=0.0003）的唯一显著预后决定因素。
在本研究系列中，正确进行的 D1 和 D2 清扫术导致显著的（6.4%）局部区域复发率。尽管 D1 和 D2 实现了令人满意的局部区域控制，但 IIIA-B 和 IV 期胃癌患者的生存数据并未得到改善。原发肿瘤的组织病理学类型仅在根治性手术后的胃癌结局测量上显示出统计学趋势。
