Allum W H, Powell D J, McConkey C C, Fielding J W
Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
Br J Surg. 1989 Jun;76(6):535-40. doi: 10.1002/bjs.1800760604.
Between 1957 and 1981, 31,716 cases of gastric cancer were registered in the West Midlands, UK. The age-standardized incidence has shown a decrease from 17.42 per 100,000 population during the first quinquennium to 15.30 per 100,000 in the last. There was an apparent increase in the proportion of proximal lesions with a decrease in the proportion of distal, antral cancers. The stage of disease at diagnosis remained constant with 79 per cent of patients having stage IV disease. Less than 1 per cent presented with stage I disease. As a result, the curative resection rate was 21 per cent. The operative mortality rates for curative partial gastrectomy and total gastrectomy were 13 and 29 per cent respectively. Surgeons undertaking more than nine total gastrectomies annually had an overall mean operative mortality rate of 22 per cent. Overall age-adjusted survival at 5 years was 5 per cent. Survival at 5 years for stage I, II and III disease was 72, 32 and 10 per cent respectively. There was a significant increase in survival time for those treated by curative resection between 1972 and 1981 compared with the previous decade. The implications for the management of gastric cancer are discussed.
1957年至1981年间，英国西米德兰兹郡登记了31716例胃癌病例。年龄标准化发病率已显示出从第一个五年期的每10万人17.42例下降到最后一个五年期的每10万人15.30例。近端病变的比例明显增加，而远端胃窦癌的比例下降。诊断时疾病的分期保持不变，79%的患者患有IV期疾病。不到1%的患者表现为I期疾病。因此，根治性切除率为21%。根治性部分胃切除术和全胃切除术的手术死亡率分别为13%和29%。每年进行超过9例全胃切除术的外科医生的总体平均手术死亡率为22%。总体年龄调整后的5年生存率为5%。I期、II期和III期疾病的5年生存率分别为72%、32%和10%。与前十年相比，1972年至1981年间接受根治性切除治疗的患者的生存时间有显著增加。本文讨论了对胃癌治疗的启示。
