Patrick O Roberts, Joseph Plummer, Pierre-Anthony Leake, Shane Scott, Tamara G de Souza, The Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Jamaica 999172, West Indies.
World J Gastrointest Surg. 2014 Jun 27;6(6):94-100. doi: 10.4240/wjgs.v6.i6.94.
To investigate pathological factors related to long term patient survival post surgical management of gastric adenocarcinoma in a Caribbean population.
This is a retrospective, observational study of all patients treated surgically for gastric adenocarcinoma from January 1(st) 2000 to December 31(st) 2010 at The University Hospital of the West Indies, an urban Jamaican hospital. Pathological reports of all gastrectomy specimens post gastric cancer resection during the specified interval were accessed. Patients with a final diagnosis other than adenocarcinoma, as well as patients having undergone surgery at an external institution were excluded. The clinical records of the selected cohort were reviewed. The following variables were analysed; patient gender, patient age, the number of gastrectomies previous performed by the lead surgeon, the gross anatomical location and appearance of the tumour, the histological appearance of the tumour, infiltration of the tumour into stomach wall and surrounding structures, presence of Helicobacter pylori and the presence of gastritis. Patient status as dead vs alive was documented for the end of the interval. The effect of the aforementioned factors on patient survival were analysed using Logrank tests, Cox regression models, Ranksum tests, Kruskal-Wallis tests and Kaplan-Meier curves.
A total of 79 patients, 36 males and 43 females, were included. Their median age was 67 years (range 36-86 years). Median survival time from surgery was 70 mo with 40.5% of patients dying before the termination date of the study. Tumours ranged from 0.8 cm in size to encompassing the entire stomach specimen, with a median tumour size of 6 cm. The median number of nodes removed at surgery was 8 with a maximum of 28. The median number of positive lymph nodes found was 2, with a range of 0 to 22. Patients' median survival time was approximately 70 mo, with 40.5% of the patients in this cohort dying before the terminal date. An increase in the incidence of cardiac tumours was noted compared to the previous 10 year interval (7.9% to 9.1%). Patients who had serosal involvement of the tumour did have a significantly shorter survival than those who did not (P = 0.017). A significant increase in the hazard ratio (HR), 2.424, for patients with circumferential tumours was found (P = 0.044). Via Kaplan-Meier estimates, the presence of venous infiltration as well as involvement of the circumferential resection margin were found to be poor prognostic markers, decreasing survival at 50 mo by 46.2% and 36.3% respectively. The increased HR for venous infiltration, 2.424, trended toward significant (P = 0.055) Age, size of tumour, number of positive nodes found and total number of lymph nodes removed were not useful predictors of survival. It is noted that the results were mostly negative, that is many tumour characteristics did not indicate any evidence of affecting patient survival. The current sample, with 30 observed events (deaths), would have about 30% power to detect a HR of 2.5.
This study mirrors pathological factors used for gastric cancer prognostication in other populations. As evaluation continues, a larger cohort will strengthen the significance of observed trends.
研究加勒比地区人群接受胃腺癌手术后长期生存的相关病理因素。
这是一项回顾性、观察性研究，纳入了 2000 年 1 月 1 日至 2010 年 12 月 31 日在西印度群岛大学医院接受胃腺癌手术治疗的所有患者。获取了指定期间内所有胃切除术后胃癌切除标本的病理报告。排除了最终诊断为腺癌以外的患者，以及在外部机构接受手术的患者。对选定队列的临床记录进行了回顾。分析了以下变量：患者性别、患者年龄、主刀医生之前进行的胃切除术数量、肿瘤的大体解剖位置和外观、肿瘤的组织学表现、肿瘤对胃壁和周围结构的浸润、幽门螺杆菌的存在和胃炎的存在。记录患者在研究结束时的生存状态（死亡或存活）。使用对数秩检验、Cox 回归模型、Ranksum 检验、Kruskal-Wallis 检验和 Kaplan-Meier 曲线分析上述因素对患者生存的影响。
共纳入 79 名患者，其中男性 36 名，女性 43 名。他们的中位年龄为 67 岁（范围 36-86 岁）。手术中位生存时间为 70 个月，40.5%的患者在研究截止日期前死亡。肿瘤大小从 0.8 厘米到整个胃标本不等，中位肿瘤大小为 6 厘米。手术时切除的淋巴结中位数为 8 个，最多为 28 个。发现的阳性淋巴结中位数为 2 个，范围为 0-22 个。患者的中位生存时间约为 70 个月，该队列中有 40.5%的患者在截止日期前死亡。与前 10 年相比，心脏肿瘤的发生率有所增加（7.9%升至 9.1%）。肿瘤浆膜受累的患者的生存时间明显短于未受累的患者（P=0.017）。发现环形肿瘤患者的危险比（HR）显著增加，为 2.424（P=0.044）。通过 Kaplan-Meier 估计，静脉浸润和环周切缘受累的存在是不良预后标志物，使 50 个月的生存率分别降低了 46.2%和 36.3%。静脉浸润的 HR 为 2.424，趋势具有统计学意义（P=0.055）。年龄、肿瘤大小、阳性淋巴结数量和淋巴结总数均不是生存的有用预测因素。值得注意的是，结果大多为阴性，即许多肿瘤特征并未表明对患者生存有任何影响。当前样本中观察到 30 个事件（死亡），检测 HR 为 2.5 的置信度约为 30%。
本研究反映了其他人群用于胃腺癌预后评估的病理因素。随着评估的继续，更大的队列将增强观察趋势的意义。
