Takeuchi Akihiro, Ojima Toshiyasu, Katsuda Masahiro, Hayata Keiji, Goda Taro, Kitadani Junya, Tominaga Shinta, Fukuda Naoki, Nakai Tomoki, Yamaue Hiroki
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, 641-8510, Japan.
J Gastrointest Surg. 2022 Apr;26(4):757-763. doi: 10.1007/s11605-021-05238-0. Epub 2022 Jan 10.
Postoperative adjuvant therapy for early gastric cancer (EGC) has not been widely studied, and there are differing indications for postoperative adjuvant therapy between Western and Asian countries. Japanese gastric cancer treatment guidelines do not recommend adjuvant chemotherapy for EGC, but it is unclear whether surgery alone is the most appropriate treatment.
This is a single-center retrospective study of 1001 consecutive patients who underwent radical gastrectomy for pT1 gastric cancer between 1999 and 2013 at the Wakayama Medical University Hospital.
Recurrence was observed in 12 patients, nine of whom as the result of hematogenous metastasis. In all patients with pT1 gastric cancer (n = 1001), lymph node metastasis was identified as an independent predictive factor for recurrence (hazard ratio [HR] = 10.910, P = 0.002). In patients with pT1N + gastric cancer, however, the 5-year disease-specific survival (DSS) rate was still high, 90.8%. In patients with pT1N + gastric cancer (n = 97), the presence of venous invasion (pT1N + v +) was identified by univariate and multivariate analyses as an independent risk factor for recurrence (HR = 4.791, P = 0.032). In patients with venous invasion, the 5-year DSS rate was significantly lower than that in those without venous invasion (79.3% vs. 95.2%, P = 0.018).
Long-term prognosis of patients with EGC with lymph node metastasis is good, but venous invasion is associated with a higher risk of recurrence. Selective application of postoperative adjuvant chemotherapy for pT1N + v + gastric cancer may efficiently improve prognosis among patients with EGC.
早期胃癌（EGC）的术后辅助治疗尚未得到广泛研究，西方国家和亚洲国家在术后辅助治疗的适应证方面存在差异。日本胃癌治疗指南不推荐对EGC进行辅助化疗，但仅手术是否为最合适的治疗方法尚不清楚。
这是一项单中心回顾性研究，研究对象为1999年至2013年在和歌山县立医科大学医院连续接受pT1期胃癌根治性胃切除术的1001例患者。
观察到12例复发，其中9例为血行转移所致。在所有pT1期胃癌患者（n = 1001）中，淋巴结转移被确定为复发的独立预测因素（风险比[HR]=10.910，P = 0.002）。然而，在pT1N+期胃癌患者中，5年疾病特异性生存率（DSS）仍然很高，为90.8%。在pT1N+期胃癌患者（n = 97）中，单因素和多因素分析均表明，静脉侵犯（pT1N+v+）是复发的独立危险因素（HR = 4.791，P = 0.032）。有静脉侵犯的患者5年DSS率显著低于无静脉侵犯的患者（79.3%对95.2%，P = 0.018）。
有淋巴结转移的EGC患者的长期预后良好，但静脉侵犯与较高的复发风险相关。对pT1N+v+期胃癌选择性应用术后辅助化疗可能有效改善EGC患者的预后。
