Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Caner Center, Guangzhou, China.
Eur J Surg Oncol. 2019 Dec;45(12):2457-2464. doi: 10.1016/j.ejso.2019.06.026. Epub 2019 Jun 20.
To investigate the factors related to positive surgical margins of gastric cancer and their correlation with the prognosis of these patients.
The clinicopathological data of gastric cancer patients undergoing gastrectomy were collected, and the relationship between surgical margins status and patient outcome was analyzed.
A total of 10080 patients were included, among which 311 (3.1%) had positive surgical margins. pT3-4, pN+ and M1 were independent risk factors for positive margins, and a tumor in the middle of the stomach was a protective factor (p < 0.05). The 5-year overall survival (OS) rates of the patients with positive and negative margins after propensity score matching (PSM) were 24.2% and 36.8%, respectively (p < 0.001). For M0 patients, the 5-year OS of the margin-positive patients was lower than that of the margin-negative patients, and was higher than that of patients with M1. For the M1 patients, no statistically significant difference in 5-year OS was noted between patients with positive and negative margins. Age, positive margins, tumor location, pN+, and M1 were independent prognostic factors for OS in patients undergoing gastrectomy, and pN2-3 and M1 stages were independent prognostic factors for patients with positive surgical margins. Postoperative chemotherapy could improve the 5-year OS in pN2-3 and M1 margin-positive patients (p < 0.05).
The prognosis of M0 gastric cancer patients with positive surgical margins is poor, and it is recommended that these patients should undergo routine intraoperative frozen-section pathological examination to reduce the risk of positive surgical margins.
探讨胃癌阳性切缘的相关因素及其与患者预后的关系。
收集行胃癌根治术患者的临床病理资料，分析切缘状态与患者预后的关系。
共纳入 10080 例患者，其中 311 例（3.1%）为阳性切缘。pT3-4、pN+和 M1 是阳性切缘的独立危险因素，而肿瘤位于胃中部是保护性因素（p<0.05）。倾向性评分匹配（PSM）后，阳性切缘和阴性切缘患者的 5 年总生存（OS）率分别为 24.2%和 36.8%（p<0.001）。对于 M0 患者，阳性切缘患者的 5 年 OS 低于阴性切缘患者，高于 M1 患者。对于 M1 患者，阳性切缘和阴性切缘患者的 5 年 OS 无统计学差异。年龄、阳性切缘、肿瘤位置、pN+和 M1 是胃癌根治术患者 OS 的独立预后因素，pN2-3 和 M1 期是阳性切缘患者的独立预后因素。术后化疗可提高 pN2-3 和 M1 阳性切缘患者的 5 年 OS（p<0.05）。
M0 期胃癌患者阳性切缘的预后较差，建议这些患者常规行术中冰冻切片病理检查，以降低阳性切缘的风险。
