Jeong Oh, Park Young Kyu, Choi Won Yong, Ryu Seong Yeop
Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea,
Ann Surg Oncol. 2014 Aug;21(8):2587-93. doi: 10.1245/s10434-014-3638-1. Epub 2014 Mar 17.
To date, there is no convincing evidence regarding the benefits of non-curative gastrectomy for gastric carcinoma. In the present study, we reviewed the outcomes of patients who underwent surgery for incurable gastric carcinoma and evaluated the prognostic significance of non-curative gastrectomy.
Between 2004 and 2011, a total of 197 patients undergoing elective surgery for incurable gastric carcinoma were divided into the gastric resection and non-resection groups. Patient survival was compared between the two groups, and the prognostic significance of non-curative gastrectomy was investigated using multivariate analysis.
Overall, 162 (82.2 %) patients underwent non-curative gastrectomy with morbidity and mortality of 21.0 and 1.2 %, respectively. The median survival of patients undergoing non-curative gastrectomy was significantly longer than that of patients without gastrectomy (12.4 vs. 7.1 months, p = 0.003). Patients who received postoperative chemotherapy also showed significantly better survival than those without chemotherapy (13.2 vs. 4.3 months, p < 0.001). Multivariate analysis revealed that non-curative gastrectomy was an independent prognostic factor (hazard ratio 0.61, 95 % CI 0.40-0.93, p = 0.023) after adjusting for postoperative chemotherapy and other clinical factors. Median survival in patients receiving non-curative gastrectomy combined with postoperative chemotherapy was 13.9 months, which was significantly longer than gastrectomy alone (5.4 months), chemotherapy alone (9.6 months), and no treatment (3.2 months) (p < 0.001).
Primary tumor resection and postoperative chemotherapy are the most important prognostic factors for incurable gastric carcinoma. The survival benefits of non-curative gastrectomy need to be confirmed in a large-scale, randomized trial.
迄今为止，尚无关于非根治性胃癌切除术对胃癌益处的确凿证据。在本研究中，我们回顾了接受不可治愈性胃癌手术患者的结局，并评估了非根治性胃切除术的预后意义。
2004年至2011年期间，共有197例行择期不可治愈性胃癌手术的患者被分为胃切除组和非切除组。比较两组患者的生存情况，并使用多因素分析研究非根治性胃切除术的预后意义。
总体而言，162例（82.2%）患者接受了非根治性胃切除术，其发病率和死亡率分别为21.0%和1.2%。接受非根治性胃切除术患者的中位生存期明显长于未行胃切除术的患者（12.4个月对7.1个月，p = 0.003）。接受术后化疗的患者生存率也明显高于未接受化疗的患者（13.2个月对4.3个月，p < 0.001）。多因素分析显示，在调整术后化疗和其他临床因素后，非根治性胃切除术是一个独立的预后因素（风险比0.61，95%可信区间0.40 - 0.93，p = 0.023）。接受非根治性胃切除术联合术后化疗患者的中位生存期为13.9个月，明显长于单纯胃切除术（5.4个月）、单纯化疗（9.6个月）和未治疗（3.2个月）（p < 0.001）。
原发性肿瘤切除和术后化疗是不可治愈性胃癌最重要的预后因素。非根治性胃切除术的生存益处需要在大规模随机试验中得到证实。
