Imamura Taisuke, Komatsu Shuhei, Ichikawa Daisuke, Kubota Takeshi, Okamoto Kazuma, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Morimura Ryo, Murayama Yasutoshi, Kuriu Yoshiaki, Ikoma Hisashi, Nakanishi Masayoshi, Sakakura Chouhei, Otsuji Eigo
Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Japan.
J Surg Oncol. 2015 Feb;111(2):221-5. doi: 10.1002/jso.23796. Epub 2014 Oct 18.
Adjuvant chemotherapy following curative gastrectomy is recommended for patients with pStage II or III, except pT3 (ss), N0 gastric cancer in Japan. This study aimed to detect the poor prognostic subgroup of T3N0 gastric cancer, suggesting an indication for adjuvant chemotherapy.
Between 1999 and 2011, 116 patients with pStage IIA gastric cancer underwent curative gastrectomy. We reviewed their hospital records retrospectively.
The 5-year overall survival (OS) rates of patients with T1N2+T2N1 and T3N0 gastric cancer were 79% and 77%, respectively. Univariate and multivariate analyses revealed lymphatic invasion (LY+) to be an independent poor prognostic factor in T3N0 gastric cancer [P=0.004, HR 12.3 (95% CI: 2.07-112)]. The prognosis of patients with T3N0LY+ gastric cancer was significantly poorer than those with other pStage IIA gastric cancer (5-year OS; T3N0LY+ vs. other Stage IIA: 68% vs. 83%, P=0.043). The incidence of peritoneal recurrence was higher in patients with T3N0LY+ gastric cancer than in those with other Stage IIA gastric cancer (T3N0LY+ vs. other stage IIA: 9.0% vs. 2.8%, P=0.134).
Lymphatic invasion was an independent poor prognostic factor in T3N0 gastric cancer. Adjuvant chemotherapy should be recommended to patients with T3N0LY+ gastric cancer.
在日本，除了pT3（ss）、N0的胃癌患者外，对于pII期或III期患者，建议在根治性胃切除术后进行辅助化疗。本研究旨在检测T3N0胃癌的预后不良亚组，以提示辅助化疗的指征。
1999年至2011年间，116例pIIA期胃癌患者接受了根治性胃切除术。我们回顾性地查阅了他们的医院记录。
T1N2+T2N1和T3N0胃癌患者的5年总生存率（OS）分别为79%和77%。单因素和多因素分析显示，淋巴血管浸润（LY+）是T3N0胃癌独立的预后不良因素[P=0.004，HR 12.3（95%CI：2.07-112）]。T3N0LY+胃癌患者的预后明显比其他pIIA期胃癌患者差（5年OS；T3N0LY+ vs.其他IIA期：68% vs. 83%，P=0.043）。T3N0LY+胃癌患者的腹膜复发发生率高于其他IIA期胃癌患者（T3N0LY+ vs.其他IIA期：9.0% vs. 2.8%，P=0.134）。
淋巴血管浸润是T3N0胃癌独立的预后不良因素。对于T3N0LY+胃癌患者，应建议进行辅助化疗。
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