Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, Morimoto T, Kato T, Kito T
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
J Am Coll Surg. 1996 Nov;183(5):480-5.
Borrmann type IV gastric carcinoma carries a poor prognosis, even if curatively resected. The benefit of a lymphadenectomy is unknown.
A retrospective study was designed to evaluate whether improvements have been made in the treatment of type IV gastric carcinoma over the past decade. The 345 patients with type IV carcinoma who underwent laparotomy within a recent 16-year period were split into two groups: one group of patients who underwent laparotomy between 1977 and 1985, and the other between 1986 and 1992. Survival data were compared between these two groups and prognostic factors for type IV gastric carcinoma were assessed by multivariate analysis.
A significant difference in survival was observed between the groups, both of which underwent curative resection, despite a lack of difference in background factors. The improvement was more prominent among patients with nodal metastases and insignificant among patients without nodal metastases. Multivariate analysis identified nodal metastasis as a major independent prognostic factor.
An improvement in outcome was presumably achieved through extended lymphadenectomy. However, the survival rate remains unsatisfactory, and further advances in the treatment of this disease are needed.
即使接受了根治性切除，Borrmann IV型胃癌的预后仍然很差。淋巴结清扫术的益处尚不清楚。
一项回顾性研究旨在评估过去十年中IV型胃癌的治疗是否有所改善。在最近16年期间接受剖腹手术的345例IV型癌患者被分为两组：一组是在1977年至1985年间接受剖腹手术的患者，另一组是在1986年至1992年间接受剖腹手术的患者。比较两组的生存数据，并通过多变量分析评估IV型胃癌的预后因素。
尽管背景因素没有差异，但两组接受根治性切除的患者在生存方面存在显著差异。这种改善在有淋巴结转移的患者中更为显著，而在没有淋巴结转移的患者中则不显著。多变量分析确定淋巴结转移是主要的独立预后因素。
通过扩大淋巴结清扫术可能实现了预后的改善。然而，生存率仍然不尽人意，需要在这种疾病的治疗上取得进一步进展。
