Koumarianou Anna, Krivan Sylvia, Machairas Nikolaos, Ntavatzikos Anastasios, Pantazis Nikos, Schizas Dimitrios, Martikos George, Kampoli Katerina, Misiakos Evangelos P, Patapis Pavlos, Liakakos Theodoros
Hematology Oncology Unit, Fourth Department of Internal Medicine (Anna Koumarianou, Katerina Kampoli).
Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos).
Ann Gastroenterol. 2019 Jan-Feb;32(1):99-106. doi: 10.20524/aog.2018.0320. Epub 2018 Oct 3.
Despite therapeutic advancements, gastric cancer (GC) remains a leading cause of death worldwide.
This retrospective cohort study statistically analyzed the clinicopathologic characteristics, treatments and outcomes of patients with potentially resectable GC managed at our institution between 2006 and 2010. The STROBE checklist was applied.
Preoperative assessment of 164 GC patients (male: female ratio 1.87, median age 65 years) assigned 132 (80.5%) to total (56; 42.4%) or subtotal (76; 57.6%) gastrectomy. Resection margins were microscopically tumor-free (R0) in 100 (75.8%), microscopically infiltrated (R1) in 25 (18.9%) and macroscopically infiltrated (R2) in 7 (5.3%) patients. Nodal plane dissection was D0 in 34 (25.8%), D1 in 62 (47.0%) and D2 in 36 (27.3%) patients. Early GC was diagnosed in 19 patients (14.4%). Fluorouracil-based chemotherapy was administered in 69.7% and chemoradiation in 18.2% of patients. The 5- and 10-year survival rates of patients with R0 resection were 74% and 65.4%, respectively. The 2-year survival rates for R1 and R2 resection were 28.9% and 0% respectively. The 5- and 10-year survival rates according to nodal plane dissection were 55.6% and 41.4% for D2, and 53.2% and 49.7% for D1, respectively. On multivariate analysis, T4, N3 and R1/R2 remained independent negative prognostic factors for overall survival. Microscopic or macroscopic infiltration of surgical margins was the worst adverse prognostic factor for survival.
These results are equivalent to those from centers of excellence and indicate the urgent need for improvements in the field, particularly in the development of predictive models to guide personalized therapy.
尽管治疗取得了进展，但胃癌（GC）仍是全球主要的死亡原因之一。
这项回顾性队列研究对2006年至2010年间在我们机构接受治疗的潜在可切除胃癌患者的临床病理特征、治疗方法和预后进行了统计分析。应用了STROBE清单。
对164例胃癌患者（男：女比例为1.87，中位年龄65岁）进行术前评估，其中132例（80.5%）接受了全胃切除术（56例；42.4%）或次全胃切除术（76例；57.6%）。100例（75.8%）患者的切除边缘显微镜下无肿瘤（R0），25例（18.9%）患者显微镜下有浸润（R1），7例（5.3%）患者肉眼有浸润（R2）。34例（25.8%）患者的淋巴结清扫为D0，62例（47.0%）患者为D1，36例（27.3%）患者为D2。19例患者（14.4%）诊断为早期胃癌。69.7%的患者接受了基于氟尿嘧啶的化疗，18.2%的患者接受了放化疗。R0切除患者的5年和10年生存率分别为74%和65.4%。R1和R2切除患者的2年生存率分别为28.9%和0%。根据淋巴结清扫情况，D2患者的5年和10年生存率分别为55.6%和41.4%，D1患者分别为53.2%和49.7%。多因素分析显示，T4、N3和R1/R2仍然是总生存的独立负性预后因素。手术切缘的显微镜下或肉眼浸润是生存最差的不良预后因素。
这些结果与卓越中心的结果相当，表明该领域迫切需要改进，特别是在开发预测模型以指导个性化治疗方面。
