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残胃癌的临床病理特征及预后因素:单中心回顾性分析 90 例患者

Clinicopathological characteristics and prognostic factors of remnant gastric cancer: A single-center retrospective analysis of 90 patients.

机构信息

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Int J Surg. 2018 Mar;51:97-103. doi: 10.1016/j.ijsu.2018.01.019. Epub 2018 Jan 31.

Abstract

BACKGROUND

The prognosis of remnant gastric cancer (RGC) is significantly poor. However, the mechanism and some clinical features of RGC have not been fully understood and are still under debate.

MATERIALS AND METHODS

From January 2000 to January 2014, 90 RGC patients were enrolled in this retrospective study. Patients were divided into two groups according to primary disease. Clinicopathological features and survival outcomes were compared between two groups.

RESULTS

A total of 34 (37.8%) patients were diagnosed with remnant gastric cancer following benign disease (RGCB) and 56 (62.2%) were diagnosed with remnant gastric cancer following malignant disease (RGCM). The mean time interval from the primary operation to the development of RGC was 12.5 ± 13.3 years in all RGC patients. The mean time interval in RGCB was significantly longer than that in RGCM (P < 0.01). The 1-, 2-, and 3- year overall survival rates of all patients were 56.1%, 38.2% and 33.2%, respectively. Univariate analysis indicated that tumor size, curability, histology type, serosa invasion, nodal involvement and distant metastasis were prognostic factors for RGC. The multivariate Cox regression analysis revealed that distant metastasis was an independent prognostic factor for RGC.

CONCLUSION

RGC occurred earlier in patients with gastrectomy for primary malignant disease than for primary benign disease, even though the primary disease made no difference to the survival of RGC. Nonetheless, RGC patients experienced dismal overall survival. Therefore, early diagnosis plays a significant role in successfully carrying out curative resection and improving the prognosis for RGC.

摘要

背景

残胃癌(RGC)的预后明显较差。然而,RGC 的发病机制和一些临床特征尚未完全了解,仍存在争议。

材料与方法

回顾性分析 2000 年 1 月至 2014 年 1 月间收治的 90 例 RGC 患者,根据原发病将患者分为两组,比较两组患者的临床病理特征和生存结局。

结果

本组 90 例患者中,34 例(37.8%)原发病为良性疾病(RGCB),56 例(62.2%)原发病为恶性疾病(RGCM)。所有 RGC 患者从首次手术到发生 RGC 的时间间隔为 12.5±13.3 年。RGCB 组的时间间隔明显长于 RGCM 组(P<0.01)。所有患者的 1、2、3 年总生存率分别为 56.1%、38.2%和 33.2%。单因素分析显示,肿瘤大小、可切除性、组织学类型、浆膜侵犯、淋巴结转移和远处转移是影响 RGC 预后的因素。多因素 Cox 回归分析显示,远处转移是影响 RGC 的独立预后因素。

结论

与原发良性疾病相比,原发恶性疾病行胃大部切除术后发生 RGC 的时间更早,而原发病对 RGC 的生存无影响。但 RGC 患者的总体生存仍较差。因此,早期诊断对于成功进行根治性切除和改善 RGC 的预后具有重要意义。

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