Sano T, Sasako M, Kinoshita T, Maruyama K
Department of Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan.
Cancer. 1993 Dec 1;72(11):3174-8. doi: 10.1002/1097-0142(19931201)72:11<3174::aid-cncr2820721107>3.0.co;2-h.
The outcome of surgical treatment for early gastric cancer (EGC) generally is considered to be satisfactory. Although a small percentage of patients experience disease recurrence, the absolute number of such instances is too small for assessment of risk factors.
The authors investigated the follow-up records of 1475 patients with EGC treated at the National Cancer Center, Tokyo, with special reference to cancer recurrence. In addition, 20 Japanese reports on this subject were reviewed.
Excluding operative deaths and patients with noncurative operations, 20 (1.4%) patients died of recurrent disease. The death rate associated with other causes (6.6%), including other malignant diseases, surpassed that associated with disease recurrence. Late recurrence (after 5 years) was seen in seven patients. By combining the data of patients reported in 20 articles in the literature, the authors estimated a recurrence rate for EGC of at least 1.9%, exclusive of cancers arising in the gastric stump. The incidence of recurrence was significantly higher in submucosal (3.6%), node-positive (10.7%), and histologically differentiated carcinomas (2.3%) than in mucosal, node-negative, and undifferentiated groups, respectively. Analysis of 123 instances of recurrent disease, the details of which had been reported, revealed that hematogenous metastasis was the most common mode of recurrence. The mean survival period of patients with recurrent disease was 40 months, and 23% of patients died more than 5 years after surgery.
It is rare for EGC to recur, even in patients with tumors with a comparatively high risk of recurrence. Long-term follow-up of patients with positive nodes for hematogenous spread might facilitate early detection of disease recurrence.
早期胃癌（EGC）手术治疗的结果通常被认为是令人满意的。尽管有一小部分患者会出现疾病复发，但此类病例的绝对数量过少，无法评估危险因素。
作者调查了东京国立癌症中心治疗的1475例EGC患者的随访记录，特别关注癌症复发情况。此外，还回顾了20篇关于该主题的日本报告。
排除手术死亡病例和非根治性手术患者，20例（1.4%）患者死于复发性疾病。包括其他恶性疾病在内的其他原因导致的死亡率（6.6%）超过了疾病复发导致的死亡率。7例患者出现晚期复发（5年后）。通过合并文献中20篇文章报道的患者数据，作者估计EGC的复发率至少为1.9%，不包括胃残端发生的癌症。黏膜下癌（3.6%）、淋巴结阳性癌（10.7%）和组织学分化癌（2.3%）的复发率分别显著高于黏膜癌、淋巴结阴性癌和未分化癌组。对已报道详细情况的123例复发病例进行分析，发现血行转移是最常见的复发方式。复发性疾病患者的平均生存期为40个月，23%的患者在手术后5年以上死亡。
即使是复发风险相对较高的肿瘤患者，EGC复发也很少见。对淋巴结阳性且有血行播散的患者进行长期随访可能有助于早期发现疾病复发。
