[弥漫型进展期胃癌手术方法及预后的临床研究]

Yang Jie, Li Long, Zhang Gengyuan, Zhou Huinian, Yu Zeyuan, Jiao Zuoyi

First Department of General Surgery, Second Hospital Affiliated to Lanzhou University, Lanzhou 730030, China.

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Feb;41(2):151-7. doi: 10.11817/j.issn.1672-7347.2016.02.006.

OBJECTIVE

To explore the prognosis and surgical method for diffuse-type advanced gastric cancer (AGC).

METHODS

The clinicopathological data of patient, who underwent curative gastrectomy in the Second Hospital Affiliated to Lanzhou University from 2005 to 2010, were analyzed retrospectively. The prognostic factors of diffuse-type AGC were analyzed by Cox regression models. The patients were divided into a total gastrectomy group (n=120) and a subtotal gastrectomy group (n=167) according to the surgical approach. Survival rates were established by the Kaplan-Meier method and compared by the Log-rank test between the total gastrectomy group and the subtotal gastrectomy group.

RESULTS

A total of 287 patients with diffuse-type AGC were enrolled in this study, including 120 patients in the total gastrectomy group and 167 patients in the subtotal gastrectomy group. Univariate analysis showed that the prognosis of diffuse-type AGC was associated with body mass index, number of retrieved lymph nodes, Borrmann type, tumor size, T stage, N stage, tumor-node-metastasis (TNM) stage, extent of resection, surgical margin, postoperative complication, perineural and vascular invasion (all P<0.01). Multivariate analysis showed that normal body mass index, tumor size, T stage, N stage, total gastrectomy, surgical margin, postoperative complication were the independent predictors for diffuse-type AGC (all P<0.05). The 5-year overall survival rate and progression-free survival rate for diffuse-type AGC after curative gastrectomy were 17.8% and 13.6%, respectively. The median survival time and progression-free survival of them were 22 and 18 months, respectively. The overall survival rate and progression-free survival rate in the total gastrectomy group was significantly higher than that in the subtotal gastrectomy (P<0.01); the extended extent of lymph node dissection, the lower rate of positive surgical margin and postoperative complications were present in the total gastrectomy group (all P<0.05 or P<0.01).

CONCLUSION

The patients with diffuse-type AGC have a poor prognosis. The great tumor diameter, advanced T stage, advanced N stage, subtotal gastrectomy, high rate of positive surgical margin and postoperative complication are independent risky factors for the diffuse-type AGC. However, the total gastrectomy may be beneficial to patients.

目的

探讨弥漫型进展期胃癌（AGC）的预后及手术方式。

方法

回顾性分析2005年至2010年在兰州大学第二医院接受根治性胃切除术患者的临床病理资料。采用Cox回归模型分析弥漫型AGC的预后因素。根据手术方式将患者分为全胃切除术组（n = 120）和胃大部切除术组（n = 167）。采用Kaplan-Meier法计算生存率，并通过Log-rank检验比较全胃切除术组和胃大部切除术组的生存率。

结果

本研究共纳入287例弥漫型AGC患者，其中全胃切除术组120例，胃大部切除术组167例。单因素分析显示，弥漫型AGC的预后与体重指数、淋巴结清扫数目、Borrmann分型、肿瘤大小、T分期、N分期、肿瘤-淋巴结-转移（TNM）分期、切除范围、手术切缘、术后并发症、神经和血管侵犯均有关（均P < 0.01）。多因素分析显示，正常体重指数、肿瘤大小、T分期、N分期、全胃切除术、手术切缘、术后并发症是弥漫型AGC的独立预测因素（均P < 0.05）。根治性胃切除术后弥漫型AGC的5年总生存率和无进展生存率分别为17.8%和13.6%。其总生存时间和无进展生存时间分别为22个月和18个月。全胃切除术组的总生存率和无进展生存率显著高于胃大部切除术组（P < 0.01）；全胃切除术组淋巴结清扫范围更广，手术切缘阳性率和术后并发症发生率更低（均P < 0.05或P < 0.01）。