Niimoto M, Hirono M, Hattori T, Nakajima T, Hirata K, Iwanaga T, Kimura T, Nakazato H, Inokuchi K, Sugimachi K
Gan To Kagaku Ryoho. 1986 Apr;13(4 Pt 2):1475-83.
In patients who have undergone gastrectomy for gastric cancer, the use of adjuvant chemotherapy has now become very widespread in Japan. The possibility of secondary malignancies in these patients emerges as a long-term effect of these therapeutic agents. This collaborative study was done to examine the possibility of secondary malignancies resulting from both operative methods and anticancer agents at the surgical departments of seven major institutions in Japan. The study was carried out using questionnaires for all patients with gastric cancer who had undergone gastrectomy between 1960 and 1975 in those hospitals and who had survived more than one year after gastrectomy. A total of 235 secondary malignancies (2.32%) were noted among 10,138 gastrectomized patients, and 22 cancers of the gastric remnant (0.29%) were recorded among 7,672 subtotal gastrectomized cases. Cancers suspected to be recurrent gastric cancer were all excluded. As to anticancer agents, Mitomycin C (MMC), 5-Fluorouracil (5-FU) or Tegafur and Cyclophosphamide (EDX) were analyzed. The occurrence rate of secondary cancers in gastric cancer patients was calculated in many instances by dividing the actual number of secondary cancers by the total time at risk (person-years). Patients with gastric cancer who had undergone gastric resection revealed a lower incidence of secondary malignancies than had been expected. The most common secondary cancers were those occurring in the digestive system, followed by those of the respiratory system. With regard to MMC, 67 secondary cancers (2.21%) occurred in the MMC group and 168 cancers (2.36%) in the non-MMC group. Although the overall incidence of secondary cancers showed no difference between MMC and non-MMC groups, secondary cancers of the digestive system were less common in the MMC group than in the non-MMC group. A total of 22 cancers originated in the gastric remnant out of 7,672 subtotally resected stomachs. The interval between the first operation and cancer of the gastric remnant varied greatly without showing any detectable trend. Nine cancers were observed to involve the anastomotic site while 14 did not involve the anastomotic site. The incidence of cancer of the gastric remnant tended to be slightly higher with the Billroth II method than in the Billroth I method, but there was no difference in the site of secondary malignancy between the two groups.
在因胃癌接受胃切除术的患者中，辅助化疗的应用在日本现已非常普遍。这些患者发生继发性恶性肿瘤的可能性是这些治疗药物的一种长期影响。这项合作研究旨在调查日本七家主要机构外科中手术方法和抗癌药物导致继发性恶性肿瘤的可能性。该研究通过对1960年至1975年间在这些医院接受胃切除术且胃切除术后存活超过一年的所有胃癌患者进行问卷调查来开展。在10138例接受胃切除术的患者中，共发现235例继发性恶性肿瘤（2.32%），在7672例次全胃切除病例中记录到22例残胃癌（0.29%）。疑似复发性胃癌的病例均被排除。对于抗癌药物，分析了丝裂霉素C（MMC）、5-氟尿嘧啶（5-FU）或替加氟以及环磷酰胺（EDX）。在很多情况下，胃癌患者继发性癌症的发生率是通过将继发性癌症的实际数量除以总风险时间（人年）来计算的。接受胃切除的胃癌患者继发性恶性肿瘤的发生率低于预期。最常见的继发性癌症发生在消化系统，其次是呼吸系统。关于MMC，MMC组发生67例继发性癌症（2.21%），非MMC组发生168例癌症（2.36%）。虽然MMC组和非MMC组继发性癌症的总体发生率没有差异，但MMC组消化系统继发性癌症比非MMC组少见。在7672例次胃次全切除病例中，共有22例癌症起源于残胃。首次手术与残胃癌之间的间隔差异很大，未显示出任何可检测到的趋势。观察到9例癌症累及吻合口，14例未累及吻合口。残胃癌的发生率采用毕罗Ⅱ式手术时往往略高于毕罗Ⅰ式手术，但两组继发性恶性肿瘤的部位没有差异。
