Ichikura T, Fujino K, Ikawa H, Tomimatsu S, Uefuji K, Tamakuma S
First Department of Surgery, National Defense Medical College, Tokorozawa, Japan.
Surg Today. 1993;23(9):759-64. doi: 10.1007/BF00311616.
In this study, 168 patients who underwent curative resection for gastric cancer with prognostic serosal invasion [ps(+)] and 150 without prognostic serosal invasion [ps(-)] were analyzed separately to determine the prognostic importance of clinicopathological factors, and identify which patients were at high risk of recurrence. A multivariate analysis of survival time using Cox's proportional hazard model revealed the important prognostic factors to be: Lymph node involvement, the classification of gross appearance, macroscopic serosal invasion, and interstitial connective tissue in the ps(+) group; and lymph node involvement, macroscopic serosal invasion, and venous invasion in the ps(-) group. We proposed a risk score of recurrence based on the results of a further multivariate analysis called Hayashi's Quantification Analysis II, in which recurrence was chosen as an objective variable and the above prognostic factors were chosen as explanatory variables. Eighty-four percent of the patients with a score of 0 or higher in the ps(+) group and 83% of those with a score of +6 or higher in the ps(-) group showed recurrence. Thus, we believe that this score is useful for identifying those patients at high risk of recurrence, who should receive intensive chemotherapy even after curative resection.
在本研究中，分别分析了168例接受胃癌根治性切除且伴有预后性浆膜侵犯[ps(+)]的患者和150例无预后性浆膜侵犯[ps(-)]的患者，以确定临床病理因素的预后重要性，并识别哪些患者具有高复发风险。使用Cox比例风险模型对生存时间进行多变量分析显示，ps(+)组的重要预后因素为：淋巴结受累、大体外观分类、肉眼浆膜侵犯和间质结缔组织；ps(-)组的重要预后因素为：淋巴结受累、肉眼浆膜侵犯和静脉侵犯。基于进一步的多变量分析（称为林氏量化分析II）结果，我们提出了复发风险评分，其中将复发作为目标变量，上述预后因素作为解释变量。ps(+)组中评分0或更高的患者有84%出现复发，ps(-)组中评分+6或更高的患者有83%出现复发。因此，我们认为该评分有助于识别那些具有高复发风险的患者，这些患者即使在根治性切除后也应接受强化化疗。
