Hanyu Takaaki, Matsuki Atsushi, Kosugi Shin-ichi, Ishikawa Takashi, Nashimoto Atsushi, Yabusaki Hiroshi, Aizawa Masaki, Ichikawa Hiroshi, Shimada Yoshifumi, Hirose Yuki, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
Surgery. 2015 Apr;157(4):716-22. doi: 10.1016/j.surg.2014.10.009. Epub 2014 Nov 3.
The aims of this study were to identify prognostic factors of patients with submucosa-invasive (T1b) gastric cancer and to verify the validity of adjuvant chemotherapy for this disease.
We retrospectively examined the cases of 1,236 consecutive patients in our prospectively maintained database with T1b gastric cancer who underwent gastrectomy in 1995-2012. We used 11 clinicopathologic characteristics to identify prognostic factors by univariate and multivariate analyses. We compared the survival of the 160 node-positive T1b gastric cancer patients with that of 133 patients in the same database who had node-positive muscularis propria-invasive (T2) gastric cancer and had undergone gastrectomy without adjuvant chemotherapy during the same period, as a reference cohort.
The 5-year overall survival rate was 91.4% for all 1,236 patients. Advanced age (hazard ratio [HR] 4.51; 95% confidence interval [CI] 3.26-6.24; P < .01), male sex (HR 2.26; 95% CI 1.56-3.26; P < .01), and the presence of lymph node metastasis (HR 1.89; 95% CI 1.33-2.70; P < .01) were independent prognostic factors. The 5-year overall survival rates were 92.5% in node-negative patients, 84.5% in patients with 1 or 2 metastatic nodes, and 80.1% in patients with 3 or more metastatic nodes (P < .01). The 5-year overall survival rates of the node-positive T1b and T2 gastric cancer patients were 83.6% and 81.2%, respectively (P = .73).
The prognosis of node-positive T1b gastric cancer patients after curative gastrectomy was unsatisfactory. Adjuvant chemotherapy should be considered for these patients, especially those with 3 or more metastatic nodes.
本研究旨在确定黏膜下浸润性（T1b）胃癌患者的预后因素，并验证该疾病辅助化疗的有效性。
我们回顾性研究了1995年至2012年期间在我们前瞻性维护的数据库中连续1236例接受胃切除术的T1b胃癌患者的病例。我们使用11种临床病理特征，通过单因素和多因素分析来确定预后因素。我们将160例淋巴结阳性的T1b胃癌患者的生存率与同一数据库中133例同期接受胃切除术且未接受辅助化疗的淋巴结阳性肌层浸润性（T2）胃癌患者的生存率进行比较，作为参考队列。
1236例患者的5年总生存率为91.4%。高龄（风险比[HR]4.51；95%置信区间[CI]3.26 - 6.24；P <.01）、男性（HR 2.26；95%CI 1.56 - 3.26；P <.01）和存在淋巴结转移（HR 1.89；95%CI 1.33 - 2.70；P <.01）是独立的预后因素。淋巴结阴性患者的5年总生存率为92.5%，有1或2个转移淋巴结的患者为84.5%，有3个或更多转移淋巴结的患者为80.1%（P <.01）。淋巴结阳性的T1b和T2胃癌患者的5年总生存率分别为83.6%和81.2%（P =.73）。
根治性胃切除术后淋巴结阳性的T1b胃癌患者预后不理想。应考虑对这些患者进行辅助化疗，尤其是那些有3个或更多转移淋巴结的患者。
