Otowa Yasunori, Suzuki Satoshi, Kanaji Shingo, Harada Hitoshi, Tanaka Tomoko, Yamamoto Masashi, Matsuda Yoshiko, Oshikiri Taro, Nakamura Tetsu, Kakeji Yoshihiro
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Anticancer Res. 2018 Apr;38(4):2363-2368. doi: 10.21873/anticanres.12484.
BACKGROUND/AIM: Although there are a few reports recommending gastrectomy for unresectable gastric cancer (UGC) to improve survival, the advantage of gastrectomy remains unclear. The objective of this study was to assess the meanings of the surgical intervention.
Therapeutic outcomes were retrospectively evaluated in 127 patients with UGC. All patients had chemotherapy and 47 patients underwent gastrectomy. Patients were classified to three groups according to the treatment.
Multivariate analysis showed that gastrectomy was in independent favorable prognosis factor (p<0.001) as well as performance status 0/1, differentiated type, absence of distant organ metastasis, and second line chemotherapy for UGC. Among the patients with gastrectomy, R0 resection was an independent prognostic factor (p=0.011). R0 resection was mainly achieved when there was a single non-curable factor and no distant organ metastasis (p=0.007 and p=0.024, respectively).
Gastrectomy has an advantage in improving the survival in selected cases among UGC. If chemotherapy enables to control the non-curable factors, gastrectomy should be considered.
背景/目的：尽管有一些报告推荐对不可切除的胃癌（UGC）进行胃切除术以提高生存率，但胃切除术的优势仍不明确。本研究的目的是评估手术干预的意义。
对127例UGC患者的治疗结果进行回顾性评估。所有患者均接受了化疗，47例患者接受了胃切除术。根据治疗方法将患者分为三组。
多因素分析显示，胃切除术是独立的有利预后因素（p<0.001），此外还有体力状况0/1、分化型、无远处器官转移以及UGC的二线化疗。在接受胃切除术的患者中，R0切除是独立的预后因素（p=0.011）。当存在单一不可治愈因素且无远处器官转移时，主要实现R0切除（分别为p=0.007和p=0.024）。
胃切除术在改善UGC部分病例的生存率方面具有优势。如果化疗能够控制不可治愈因素，则应考虑胃切除术。
