Roder J D, Böttcher K, Siewert J R, Busch R, Hermanek P, Meyer H J
Chirurgische Klinik, Technischen Universität München, Germany.
Cancer. 1993 Oct 1;72(7):2089-97. doi: 10.1002/1097-0142(19931001)72:7<2089::aid-cncr2820720706>3.0.co;2-h.
The impact of patient- and tumor-dependent factors and the postoperative course on the prognosis of patients who underwent resection for gastric carcinoma between 1986 and 1989 were analyzed in a prospective multicenter observation study.
Resection techniques, the extent of lymph node dissection, and the histopathologic assessment of the specimen were standardized at all participating centers. A total of 1654 patients were enrolled. Follow-up is complete for 99.2% of the patients, with a median follow-up time of 48 months. Prognostic factors were assessed by multivariate analysis.
In the total patient population there was an independent prognostic effect of nodal status, a International Union Against Cancer (UICC)-R0 resection, distant metastases, the pT category, three or more risk factors on preoperative risk analysis, and the presence of postoperative complications. Multivariate analysis in the subgroup of patients who had a UICC-R0 resection confirmed the nodal status as the major independent prognostic factor.
These data suggest that the prognosis of patients who undergo gastrectomy for gastric carcinoma may be improved by a complete resection of the primary tumor and its lymphatic drainage, resulting in a UICC-R0 resection. In addition, a detailed preoperative risk analysis and identification of high-risk patients and meticulous attention to the technical details of the surgical procedure to reduce the frequency of postoperative complications may improve the prognosis.
在一项前瞻性多中心观察研究中，分析了患者和肿瘤相关因素以及术后病程对1986年至1989年间接受胃癌切除术患者预后的影响。
所有参与中心的切除技术、淋巴结清扫范围和标本的组织病理学评估均标准化。共纳入1654例患者。99.2%的患者随访完整，中位随访时间为48个月。通过多因素分析评估预后因素。
在全部患者人群中，淋巴结状态、国际抗癌联盟（UICC）R0切除、远处转移、pT分类、术前风险分析中三个或更多风险因素以及术后并发症的存在具有独立的预后影响。对接受UICC-R0切除的患者亚组进行多因素分析证实，淋巴结状态是主要的独立预后因素。
这些数据表明，通过完整切除原发肿瘤及其淋巴引流，实现UICC-R0切除，可改善接受胃癌胃切除术患者的预后。此外，详细的术前风险分析和识别高危患者，以及在手术过程中精心关注技术细节以减少术后并发症的发生频率，可能会改善预后。
