经单纯经腹途径切除的近端胃癌。结果及与远端胃腺癌的比较。
Proximal gastric cancers resected via a transabdominal-only approach. Results and comparisons to distal adenocarcinoma of the stomach.
作者信息
Harrison L E, Karpeh M S, Brennan M F
机构信息
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
出版信息
Ann Surg. 1997 Jun;225(6):678-83; discussion 683-5. doi: 10.1097/00000658-199706000-00005.
OBJECTIVE
The purpose of this study is to compare the outcome of patients with proximal gastric cancer (PGC) treated by a transabdominal-only resection to that of patients with distal gastric cancer (DGC).
SUMMARY BACKGROUND DATA
It has been suggested that PGC is inherently more aggressive than DGC. The worse survival of PGC compared with that of DGC may be in part, because of the difficulty distinguishing PGC from distal esophageal adenocarcinoma. By defining a subset of PGC resected using an transabdominal-only approach, one may discriminate true PGC from distal esophageal adenocarcinoma. This subset of patients is a more appropriate comparison group when analyzing outcome relative to patients with DGC.
METHODS
A review of the prospective database for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center between July 1985 and August 1995 identified 98 patients with PGC resection via a transabdominal-only approach. Of these, 65 underwent proximal gastrectomy and 33 underwent total gastrectomy. For DGC, 258 required a distal gastrectomy and 71 required total gastrectomy.
RESULTS
The overall 5-year survival of patients with PGC was 42% (median survival, 47 months), whereas the 5-year survival for patients with DGC was 61% (median survival, 106 months, p = 0.03). Within each stage, there were no significant survival differences, but in all stages, survival was better for patients with DGC. More important, the site of the primary tumor appears to affect survival, with a worse outcome as the tumor moves proximally.
CONCLUSIONS
Despite excluding distal esophageal cancers, survival for patients with PGC remains worse than for those with DGC. Late stage of presentation could not explain this difference. It appears that PGCs are inherently more aggressive than are DGCs. In addition, site of the primary tumor appears to affect outcome, with a trend toward a worse outcome as the tumor moves proximally.
目的
本研究旨在比较仅经腹切除的近端胃癌（PGC）患者与远端胃癌（DGC）患者的治疗结果。
总结背景数据
有研究表明，PGC本质上比DGC更具侵袭性。与DGC相比，PGC患者生存率较低，部分原因可能是难以将PGC与远端食管腺癌区分开来。通过定义一组仅采用经腹入路切除的PGC患者，可以将真正的PGC与远端食管腺癌区分开来。在分析与DGC患者相关的治疗结果时，这组患者是更合适的对照组。
方法
回顾纪念斯隆凯特琳癌症中心1985年7月至1995年8月间的胃癌前瞻性数据库，确定98例仅经腹入路切除的PGC患者。其中，65例行近端胃切除术，33例行全胃切除术。对于DGC患者，258例行远端胃切除术，71例行全胃切除术。
结果
PGC患者的总体5年生存率为42%（中位生存期47个月），而DGC患者的5年生存率为61%（中位生存期106个月，p = 0.03）。在每个分期内，生存率无显著差异，但在所有分期中，DGC患者的生存率更高。更重要的是，原发肿瘤部位似乎影响生存率，随着肿瘤向近端移动，预后更差。
结论
尽管排除了远端食管癌，但PGC患者的生存率仍低于DGC患者。晚期表现并不能解释这种差异。似乎PGC本质上比DGC更具侵袭性。此外，原发肿瘤部位似乎影响治疗结果，随着肿瘤向近端移动，预后有变差的趋势。
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