Restrepo Juliana, Carvajal-Fierro Carlos Andrés, Facundo Helena, González Felipe, Ramírez Ana María, Beltran Rafael, Buitrago Ricardo, Jimenez Andrés-Felipe, Carreño José, Oliveros Ricardo
Surgical Oncology Department, National Cancer Institute, Bogotá, Colombia.
Thoracic Surgery Department, National Cancer Institute, Bogotá, Colombia.
Front Surg. 2022 Sep 7;9:969397. doi: 10.3389/fsurg.2022.969397. eCollection 2022.
Latin America is one of the regions with the highest incidence of gastric cancer. Even though, there are not reports about the patterns of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intent and the prognosis according to each dissemination pattern.
We conducted a retrospective analysis of patients with gastric adenocarcinoma treated with curative intent at the National Cancer Institute (INC) between 2010 and 2017. Demographic variables, variables associated with the primary disease and variables associated with the presence of pleuro-pulmonary opacities and metastases were collected. A univariate and multivariate logistic regression analysis was performed and survival curves were presented using the Kaplan Meier method and compared using the log-rank test. A Cox regression model was performed for multivariate analysis for overall survival.
The study included 450 patients, 51.3% were male and the median age was 63 years. Intestinal adenocarcinoma was the most frequent histological subtype, in 261 cases (58.0%). Gastric cancer initial pathological stage was stage I in 23.3% of the patients, stage II in 19.3% and stage III in 53.6%. During a median follow-up of 31.9 months, 37 (8.2%) patients developed pleuro-pulmonary opacities; among those, 14 (3.1%) met the criteria for pleuro-pulmonary metastases: 6 (1.3%) had lymphangitic metastasis, 4 (0.9%) had a mixed pattern of pleural and lung nodules, 3 (0.7%) had pleural metastasis, and only one (0.2%) had hematogenous metastasis. The median OS was 114.5 months for the entire cohort and 38.2 (95%CI, 19.2-57.2) months for patients with pleuro-pulmonary metastases. Patients with pleural metastasis and lymphangitic carcinomatosis had median survival of 24.3 (95%CI, 0.01-51.0) and 26.4 (95%CI, 18.2-34.7) months, respectively.
incidence of pleuro-pulmonary metastases in patients with gastric adenocarcinoma treated with curative intention was low. In our series, lymphangitic carcinomatosis was the main pattern of dissemination; meanwhile, hematogenous metastasis was rare and patients with pleural carcinomatosis had the lowest median survival.
拉丁美洲是胃癌发病率最高的地区之一。尽管如此，目前尚无关于接受根治性治疗的胃腺癌患者胸膜肺转移模式以及根据每种播散模式的预后情况的报道。
我们对2010年至2017年间在国家癌症研究所（INC）接受根治性治疗的胃腺癌患者进行了回顾性分析。收集了人口统计学变量、与原发性疾病相关的变量以及与胸膜肺混浊和转移相关的变量。进行了单因素和多因素逻辑回归分析，并使用Kaplan-Meier方法绘制生存曲线，采用对数秩检验进行比较。采用Cox回归模型进行总生存的多因素分析。
该研究纳入了450例患者，其中51.3%为男性，中位年龄为63岁。肠腺癌是最常见的组织学亚型，共261例（58.0%）。胃癌初始病理分期为I期的患者占23.3%，II期占19.3%，III期占53.6%。在中位随访31.9个月期间，37例（8.2%）患者出现胸膜肺混浊；其中，14例（3.1%）符合胸膜肺转移标准：6例（1.3%）为淋巴管转移，4例（0.9%）为胸膜和肺结节混合模式，3例（0.7%）为胸膜转移，仅1例（0.2%）为血行转移。整个队列的中位总生存期为114.5个月，胸膜肺转移患者的中位总生存期为38.2（95%CI，19.2 - 57.2）个月。胸膜转移和淋巴管癌病患者的中位生存期分别为24.3（95%CI，0.01 - 51.0）和26.4（95%CI，18.2 - 34.7）个月。
接受根治性治疗的胃腺癌患者胸膜肺转移的发生率较低。在我们的系列研究中，淋巴管癌病是主要的播散模式；同时，血行转移罕见，胸膜癌病患者的中位生存期最低。
