Department of Surgery, Gastric Surgery Division, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Langenbecks Arch Surg. 2019 Aug;404(5):599-604. doi: 10.1007/s00423-019-01791-0. Epub 2019 May 9.
The prognosis of patients with gastric cancer and stage IV factors is poor. However, several recent studies have identified that curative surgery followed by S-1 chemotherapy for cytology positive (CY1) only patients contributed to a better prognosis. This study was designed to compare the prognosis between curative and palliative gastrectomy followed by chemotherapy in CY1 only stage IV gastric cancer.
Between 2001 and 2016, 1507 patients underwent gastrectomy for gastric cancer. Of these, 51 consecutive patients with only CY1 factor who underwent gastrectomy followed by chemotherapy were enrolled in this study.
(1) Twenty three (45%) patients underwent curative D2 or D2+ gastrectomy, and the remaining 28 (55%) patients underwent palliative gastrectomy, followed by S-1 based or another historical recommended chemotherapy postoperatively. (2) Compared with patients undergoing palliative gastrectomy, patients undergoing curative gastrectomy had a significantly better prognosis (P = 0.042; median survival time: curative vs. palliative, 22.6 months vs. 11.8 months) and a lower incidence of recurrences (P = 0.091). Two- and five-year overall survival rates of patients following curative gastrectomy were 48.2% and 18.2%, respectively. A multivariate analysis showed that venous invasion [P = 0.006; hazard ratio (HR), 3.70 (95% CI: 1.27-9.43)] and curative gastrectomy [P < 0.005; HR, 0.28 (95% CI: 0.12-0.87)] were independent prognostic factors.
Curative gastrectomy followed by chemotherapy might be justified to improve the prognosis of patients with only CY1 Stage IV gastric cancer.
患有胃癌和 IV 期因素的患者预后较差。然而，最近的几项研究已经确定，仅细胞学阳性（CY1）患者接受根治性手术加 S-1 化疗有助于改善预后。本研究旨在比较仅 CY1 期 IV 期胃癌患者行根治性和姑息性胃切除术后化疗的预后。
2001 年至 2016 年间，1507 例患者因胃癌行胃切除术。其中，51 例仅 CY1 因素行胃切除术后化疗的连续患者入组本研究。
（1）23 例（45%）患者行根治性 D2 或 D2+胃切除术，其余 28 例（55%）患者行姑息性胃切除术，术后行 S-1 为基础或其他历史推荐的化疗。（2）与行姑息性胃切除术的患者相比，行根治性胃切除术的患者预后明显更好（P=0.042；中位生存时间：根治性 vs. 姑息性，22.6 个月 vs. 11.8 个月），复发率更低（P=0.091）。根治性胃切除术后患者的 2 年和 5 年总生存率分别为 48.2%和 18.2%。多因素分析显示静脉侵犯（P=0.006；风险比[HR]，3.70（95%可信区间：1.27-9.43））和根治性胃切除术（P<0.005；HR，0.28（95%可信区间：0.12-0.87））是独立的预后因素。
对仅 CY1 期 IV 期胃癌患者行根治性胃切除术后化疗可能有助于改善预后。
