Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University hospital Center, Place de Verdun, Lille Cedex, France.
Ann Surg Oncol. 2013 Apr;20(4):1240-9. doi: 10.1245/s10434-012-2687-6. Epub 2012 Oct 12.
Whereas palliative chemotherapy offers a median survival of approximately 10 months in advanced gastric and junctional adenocarcinoma (AGJA), the survival impact of primary tumor resection is controversial. Our purpose was to identify which AGJA patients benefit from palliative resection.
In 3,202 AGJA patients scheduled for surgery in 21 French centers between 1997 and 2010, prognostic factors were identified in palliative group and the impact of each combination of these factors on survival was studied.
Surgery was defined as palliative due to solid organ metastasis (5.6 %), localized (4.6 %) or diffuse (2.3 %) peritoneal carcinomatosis (PC), or incomplete tumoral resection (12.8 %). Median survival of AGJA patients resected with a palliative intent (n = 677) was longer than in nonresected patients (n = 532; 11.9 vs. 8.5 months, P < 0.001). Multivariable analyses identified ASA score III-IV (P < 0.001) as a predictor of postoperative mortality and solid organ metastasis (P = 0.009), localized PC (P = 0.004), diffuse PC (P = 0.046), and signet ring cell histology (SRC; P = 0.02) as predictors of survival. Only ASA I-II patients with incomplete resection without metastasis or PC, one site solid organ metastasis without PC, or localized PC without SRC had a survival benefit after palliative surgery with median survivals from 12.0 to 18.3 months. Nonresected ASA I-II patients with same risk factors had median survivals from 3.5 to 8.8 months (P < 0.05 for each).
In AGJA, patient and tumor-related factors should be used to select candidates for palliative surgery in association with chemotherapy.
在晚期胃和胃食管结合部腺癌（AGJA）中，姑息性化疗的中位生存期约为 10 个月，而原发肿瘤切除对生存的影响存在争议。我们的目的是确定哪些 AGJA 患者从姑息性切除中获益。
在 1997 年至 2010 年间，21 家法国中心计划进行手术的 3202 例 AGJA 患者中，确定了姑息组的预后因素，并研究了这些因素的每种组合对生存的影响。
由于实体器官转移（5.6%）、局限性（4.6%）或弥漫性（2.3%）腹膜癌病（PC）或不完全肿瘤切除（12.8%），手术被定义为姑息性。姑息性切除的 AGJA 患者（n=677）的中位生存期长于未切除的患者（n=532；11.9 与 8.5 个月，P<0.001）。多变量分析确定 ASA 评分 III-IV（P<0.001）是术后死亡和实体器官转移的预测因素（P=0.009），局限性 PC（P=0.004），弥漫性 PC（P=0.046）和印戒细胞组织学（SRC；P=0.02）是生存的预测因素。仅无转移或 PC 的不完全切除且 ASA I-II 患者、无 PC 的单一部位实体器官转移或局限性 PC 且无 SRC 的患者，在姑息性手术后具有生存获益，中位生存期为 12.0 至 18.3 个月。具有相同危险因素的未切除的 ASA I-II 患者的中位生存期为 3.5 至 8.8 个月（P<0.05 每项）。
在 AGJA 中，应使用患者和肿瘤相关因素来选择姑息性手术联合化疗的候选者。
