Kito T, Yamamura Y, Kojima H
Dept. of Gastroenterological Surgery, Aichi Cancer Center Hospital.
Gan To Kagaku Ryoho. 1990 Jan;17(1):15-21.
Prognosis factors for 1,012 subjects who underwent gastrectomy for early gastric cancer were studied over a 21-year period from 1965 to 1985. We divided submucosal cancer (sm) into two subgroups, classifying the one as sm II-1 with small cancerous nests in the submucosa and the other as sm II-2. Our cases of early gastric cancer fell into the following groups: m(mucosal cancer), 451 cases; sm II-1, 106; sm II-2, 396 and multiple cancer, 59. The rate of lymph node metastasis was 1.1% in the m group, 5.7% in the sm II-1 group, 24.5% in the sm II-2 group and 6.8% in the multiple group. Gastrectomy with removal of the second-group lymph node proved adequate for sm II-2 group. The five year survival rate was 94.5% in the m group, 94.9% in sm II-1 group, 93.6% in the sm II-2 group and 91.7% in the multiple cancer group. The rate of recurrence in m group was 0.9%, against 3.3% for sm II-2 group. The sm II-2 with histologically well-differentiated type, n(+) and macroscopically Borrmann type are high-risk groups. Adjuvant chemotherapy is necessary to obtain improved surgical results for the high risk group. There was a total of 21 non-curative resection cases among which distant metastases were observed. Cases of early gastric cancer exist which are beyond help by surgical means.
在1965年至1985年的21年期间，对1012例行早期胃癌胃切除术的患者的预后因素进行了研究。我们将黏膜下癌（sm）分为两个亚组，一个亚组为sm II - 1，即黏膜下层有小癌巢，另一个亚组为sm II - 2。我们的早期胃癌病例分为以下几组：m（黏膜癌），451例；sm II - 1，106例；sm II - 2，396例；多发癌，59例。m组的淋巴结转移率为1.1%，sm II - 1组为5.7%，sm II - 2组为24.5%，多发癌组为6.8%。对sm II - 2组行胃切除术并清扫第二组淋巴结已被证明是足够的。m组的五年生存率为94.5%，sm II - 1组为94.9%，sm II - 2组为93.6%，多发癌组为91.7%。m组的复发率为0.9%，而sm II - 2组为3.3%。组织学高分化型、n（+）且宏观上为Borrmann型的sm II - 2是高危组。对于高危组，辅助化疗对于获得更好的手术效果是必要的。共有21例非根治性切除病例，其中观察到远处转移。存在一些早期胃癌病例，手术治疗已无能为力。
