Shiu M H, Moore E, Sanders M, Huvos A, Freedman B, Goodbold J, Chaiyaphruk S, Wesdorp R, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Arch Surg. 1987 Nov;122(11):1347-51. doi: 10.1001/archsurg.1987.01400230135024.
The therapeutic value of extensive gastric resection and regional lymphadenectomy in the curative treatment of gastric adenocarcinoma is controversial. We undertook a retrospective study of 210 patients treated with curative intent from 1960 to 1980. A multivariate survival analysis using the Cox model revealed five significant variables predictive of death from gastric cancer--two inherent pathologic factors: (1) nonpyloric site and (2) metastases in more than three lymph nodes, and three treatment factors that could often be controlled by the surgeon: (3) microscopic positive gastric resection margin, (4) inadequate lymphadenectomy, and (5) total gastrectomy. These observations reaffirm the value of wide gastric resection and adequate lymphadenectomy but argue against a general policy of elective total gastrectomy in the curative treatment of gastric carcinoma.
广泛胃切除术和区域淋巴结清扫术在胃癌根治性治疗中的治疗价值存在争议。我们对1960年至1980年期间接受根治性治疗的210例患者进行了回顾性研究。使用Cox模型进行的多因素生存分析显示，有五个显著变量可预测胃癌死亡——两个内在病理因素：（1）非幽门部位和（2）三个以上淋巴结转移，以及三个通常可由外科医生控制的治疗因素：（3）显微镜下胃切除边缘阳性、（4）淋巴结清扫不充分和（5）全胃切除术。这些观察结果再次肯定了广泛胃切除术和充分淋巴结清扫术的价值，但反对在胃癌根治性治疗中采用选择性全胃切除术的普遍政策。
