Squires Malcolm H, Kooby David A, Poultsides George A, Pawlik Timothy M, Weber Sharon M, Schmidt Carl R, Votanopoulos Konstantinos I, Fields Ryan C, Ejaz Aslam, Acher Alexandra W, Worhunsky David J, Saunders Neil, Levine Edward A, Jin Linda X, Cho Clifford S, Bloomston Mark, Winslow Emily R, Russell Maria C, Cardona Ken, Staley Charles A, Maithel Shishir K
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Ann Surg Oncol. 2015 Apr;22(4):1243-51. doi: 10.1245/s10434-014-4138-z. Epub 2014 Oct 15.
A proximal margin distance of 5 cm is advocated for resection of gastric adenocarcinoma (GAC). We assessed the prognostic value of proximal margin (PM) distance on survival outcomes after resection of distal GAC.
All patients who underwent resection of distal GAC (antrum/body) from 2000 to 2012 at seven institutions of the U.S. Gastric Cancer Collaborative were included. Patients with positive distal margins or macroscopic residual disease were excluded. The prognostic value of PM distance (assessed in 0.5-cm increments) on overall (OS) and recurrence-free survival (RFS) was assessed by Kaplan-Meier and multivariate regression analysis.
A total of 465 patients underwent resection of distal GAC. Of these, 435 had R0 resections; 30 patients had a positive PM. 143 patients had stage I, and 322 had stage II-III tumors. Median follow-up was 44 months. Average PM distance was 4.8 cm. Median OS for patients with PM of 3.1-5.0 cm (n = 110) was superior to patients with PM ≤ 3.0 cm (n = 176) (48.1 vs. 29.3 months; p = 0.01), while a margin >5.0 cm (n = 179) offered equivalent survival to PM 3.1-5.0 cm (50.6 months, p = 0.72). The prognostic value of margin distance was stage specific. On multivariate analysis of stage I patients, PM 3.1-5.0 cm remained associated with improved OS [hazard ratio (HR), 0.16; 95 % confidence interval (95 % CI), 0.04-0.60; p = 0.01]. In stage II-III, neither PM 3.1-5.0 cm nor PM > 5.0 cm was significantly associated with OS; OS was dictated by T stage and nodal involvement.
The prognostic value of proximal margin distance after resection of distal gastric cancer appears stage specific. In stage I, a 3.1- to 5.0-cm proximal margin is associated with the same improved OS as a > 5.0-cm margin. In stage II-III disease, other adverse pathologic factors more strongly impact survival than proximal margin distance.
对于胃腺癌（GAC）切除术，提倡近端切缘距离为5 cm。我们评估了远端GAC切除术后近端切缘（PM）距离对生存结局的预后价值。
纳入2000年至2012年在美国胃癌协作组的7家机构接受远端GAC（胃窦/胃体）切除术的所有患者。排除远端切缘阳性或有肉眼残留病灶的患者。通过Kaplan-Meier法和多因素回归分析评估PM距离（以0.5 cm递增）对总生存期（OS）和无复发生存期（RFS）的预后价值。
共有465例患者接受了远端GAC切除术。其中，435例为R0切除；30例患者近端切缘阳性。143例患者为I期，322例患者为II-III期肿瘤。中位随访时间为44个月。平均PM距离为4.8 cm。PM为3.1 - 5.0 cm的患者（n = 110）的中位OS优于PM≤3.0 cm的患者（n = 176）（48.1个月对29.3个月；p = 0.01），而切缘>5.0 cm的患者（n = 179）与PM为3.1 - 5.0 cm的患者生存期相当（50.6个月，p = 0.72）。切缘距离的预后价值具有分期特异性。在I期患者的多因素分析中，PM为3.1 - 5.0 cm仍与OS改善相关[风险比（HR），0.16；95%置信区间（95%CI），0.04 - 0.60；p = 0.01]。在II-III期，PM为3.1 - 5.0 cm和PM>5.0 cm均与OS无显著相关性；OS由T分期和淋巴结受累情况决定。
远端胃癌切除术后近端切缘距离的预后价值似乎具有分期特异性。在I期，3.1至5.0 cm的近端切缘与>5.0 cm的切缘具有相同的OS改善情况。在II-III期疾病中，其他不良病理因素对生存的影响比近端切缘距离更强。
