Jatzko G R, Lisborg P H, Denk H, Klimpfinger M, Stettner H M
Surgical Department, Hospital of Barmherzige Brüder St. Veit/Glan, Austria.
Cancer. 1995 Oct 15;76(8):1302-12. doi: 10.1002/1097-0142(19951015)76:8<1302::aid-cncr2820760803>3.0.co;2-8.
The prognosis for surgically treated gastric cancer remains poor in most Western countries compared with reports from Japanese investigators during the past 3 decades.
A radical surgical procedure principally to extended lymphadenectomy as defined by the Japanese Research Society for Gastric Cancer was performed prospectively from January 1984 to June 30, 1994 for 512 patients with gastric cancer, 345 of whom were treated with potentially curative surgery. Clinical, histopathologic, and surgical factors were examined for their influence on long term survival by univariate and multivariate analyses.
Five- and 10-year survival rates for all patients were 40.5% and 34.3%, respectively, and for patients who underwent tumor resection were 45.7% and 38.6%, respectively. For patients who underwent curative surgery, 5- and 10-year adjusted survival rates were 57.7% and 44.3%, respectively, with a median survival of 96 months. Postoperative hospital mortality was 6.8%:4.9% for R-0 resected patients, 9% for R-1 and R-2 resected patients, and 13.4% for those with palliative procedures. Multivariate analysis using the Cox model identified age older than 65 years, prior total gastrectomy, an increasing number of positive lymph nodes, a high pathologic N classification, male sex, a high pT classification, and low preoperative hemoglobin level as detrimental factors with an independent influence on survival.
Radical lymphadenectomy in this 10-year Austrian study yielded survival rates similar to those in Japanese investigations without sacrificing low postoperative mortality. In particular, the relatively high overall survival rates seemed to reaffirm the value of radical lymph node dissection with wide resection margins.
与日本研究者在过去30年的报告相比，大多数西方国家手术治疗胃癌的预后仍然很差。
1984年1月至1994年6月30日，对512例胃癌患者前瞻性地实施了主要为日本胃癌研究学会所定义的扩大淋巴结清扫术的根治性手术，其中345例接受了潜在根治性手术。通过单因素和多因素分析，研究临床、组织病理学和手术因素对长期生存的影响。
所有患者的5年和10年生存率分别为40.5%和34.3%，接受肿瘤切除的患者分别为45.7%和38.6%。接受根治性手术的患者，5年和10年调整生存率分别为57.7%和44.3%，中位生存期为96个月。术后医院死亡率为6.8%：R-0切除患者为4.9%，R-1和R-2切除患者为9%，姑息手术患者为13.4%。使用Cox模型进行的多因素分析确定，年龄大于65岁、既往全胃切除术、阳性淋巴结数量增加、高病理N分级、男性、高pT分级和术前血红蛋白水平低是对生存有独立影响的有害因素。
在这项为期10年的奥地利研究中，根治性淋巴结清扫术的生存率与日本研究相似，但并未牺牲较低的术后死亡率。特别是，相对较高的总生存率似乎再次肯定了广泛切除边缘的根治性淋巴结清扫术的价值。
