de Almeida J C, Bettencourt A, Costa C S, de Almeida J M
Department of Surgery, Instituto Português de Oncologia de Francisco Gentil, Centro de Lisboa, Clínica Oncológica III, Lisbon, Portugal.
World J Surg. 1994 Nov-Dec;18(6):889-94; discussion 894-5. doi: 10.1007/BF00299097.
From January 1980 to December 1991 we operated on 295 patients with a gastric carcinoma. In 166 cases (56.3%) surgery was performed with curative intent. In 93 patients (56%) a subtotal gastrectomy was performed, and in 73 cases (44%) a total gastrectomy. In all the cases a D-2 type lymphadenectomy was used. The global morbidity rate was 23%, and in-hospital mortality was 3.6%. The morbidity and mortality rates of these two operations were statistically different. Global 5-year survival estimate for the whole series is 61.3%. Univariate and multivariate analysis according to T and N (TNM classification), the number of positive nodes resected, and the relation of positive per resected nodes, revealed statistically different outcomes. This kind of quantitative classification allowed identification of high risk groups irrespective of site of nodal involvement. Tumors classified as intestinal or diffuse type by the Lauren classification had similar survival curves and 5-year survival estimates (p = 0.834). By univariate and multivariate analysis this classification did not reveal a prognostic value in this group of patients. In our opinion, tumor penetration and lymph node involvement are at present the most reliable prognostic factors available.
1980年1月至1991年12月，我们对295例胃癌患者进行了手术。其中166例（56.3%）进行了根治性手术。93例（56%）患者接受了胃大部切除术，73例（44%）接受了全胃切除术。所有病例均采用D-2型淋巴结清扫术。总体发病率为23%，住院死亡率为3.6%。这两种手术的发病率和死亡率在统计学上存在差异。整个系列的总体5年生存率估计为61.3%。根据T和N（TNM分类）、切除的阳性淋巴结数量以及每切除淋巴结中的阳性淋巴结关系进行单因素和多因素分析，结果显示预后存在统计学差异。这种定量分类能够识别高危组，而不考虑淋巴结受累部位。根据劳伦分类法分为肠型或弥漫型的肿瘤具有相似的生存曲线和5年生存率估计（p = 0.834）。通过单因素和多因素分析，该分类在这组患者中未显示出预后价值。我们认为，肿瘤浸润深度和淋巴结受累情况是目前最可靠的预后因素。
