Kitamura K, Beppu R, Anai H, Ikejiri K, Yakabe S, Sugimachi K, Saku M
Department of Surgery, National Kyushu Medical Center Hospital, Fukuoka, Japan.
J Surg Oncol. 1995 Feb;58(2):112-7. doi: 10.1002/jso.2930580208.
Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended.
1979年至1993年间，665例日本晚期胃癌患者在我院接受了手术。这些患者被分为两组，其中102例为Borrmann IV型癌患者，其余563例为所有其他类型的胃癌患者，然后对两组患者进行临床病理比较。在Borrmann IV型癌患者中，77.4%的病变为低分化腺癌，99例患者被归类为III期或IV期。尽管进行了70例全胃切除术，但切除率为87.2%（89/102），其中仅39例为根治性手术。这些患者的腹膜播散发生率（29.4%）和浆膜侵犯发生率（97.0%）显著更高。显微镜下淋巴结转移阳性率为86.5%。根治性手术患者的5年生存率为23.4%，非根治性手术患者的5年生存率为5.0%（p<0.01）。腹膜播散在复发模式中最为常见。我们得出结论，早期检测和根治性手术对于改善Borrmann IV型胃癌患者的预后都至关重要。还建议加用有效的术后化疗方案。
