Sheen-Chen S M, Chou C W, Chen M C, Chen F C, Chen Y S, Chen J J
Department of Surgery, Gastroenterology and Pathology, Chang Gung Memorial Hospital, Kaohsiung, Chang Gung Medical College.
Hepatogastroenterology. 1997 Sep-Oct;44(17):1488-94.
BACKGROUND/AIMS: The prognosis of patients with gastric adenocarcinoma varies with the location of the tumor. Adenocarcinoma in the middle third of the stomach has been claimed to have a better outcome than those in other locations. However, there is still very limited information specifically regarding the prognostic factors which influence the survival time of patients with adenocarcinoma in the middle third of the stomach. This retrospective study was designed with the aim to evaluate and uncover the possible significant clinicopathological parameters for adenocarcinoma in the middle third of the stomach.
Between 1986 and 1992, 363 patients underwent gastric resection for primary gastric adenocarcinoma at this hospital. Fifty-two (14.3%) of these patients were included in this study and they all met the following criteria: 1) tumor primarily located in the middle third of the stomach without distant metastases or peritoneal seeding, 2) undergoing curative resection and 3) undergoing R2 nodal dissection, at least. The clinicopathological findings were obtained by detailed review of the medical records and the histologic slides. All surviving patients were also contacted and their current conditions were recorded.
The overall 5-year survival rate (Kaplan-Meier method) was 42.5%. In univariate survival analysis by Kaplan-Meier method and long-rank test, serosal invasion (p < 0.01), lymph node metastasis (p < 0.01) and lymphatic involvement (p < 0.01) had an individual prognostic significance. When a multivariate analysis using Cox proportional hazards regression was performed, serosal invasion (P < 0.01) and lymphatic involvement (p < 0.05) appeared as the only two independent prognostic factors regarding long-term survival. When these 52 patients were categorized into patients with early gastric cancer (n = 10) and patients with advanced gastric cancer (n = 42), there was a significant difference (p < 0.01) between the survival rates (90.0% vs. 29.1%). When these tumors were further categorized into early gastric cancer (n = 10), early simulating advanced gastric cancer (n = 14) and Borrmann type advanced gastric cancer (n = 28), there were significant differences (P < 0.01 and P < 0.01, respectively) in 5-year overall survival rates between early gastric cancer (90.0%) and Borrmann type advanced gastric cancer (18.9%), also between early simulating advanced gastric cancer (52.5%) and Borrmann type advanced gastric cancer (18.9%). UICC stage also had significant influence (P < 0.01) on the survival rates.
Serosal invasion and lymphatic involvement are the significant, independent prognostic factors in predicting the survival rate of patients with adenocarcinoma in the middle third of the stomach. Since more advanced stage tumors usually carry a poorer prognosis, early detection is of extreme importance for improving the survival rate.
背景/目的：胃腺癌患者的预后因肿瘤位置而异。据称，胃中1/3的腺癌患者的预后比其他位置的患者更好。然而，关于影响胃中1/3腺癌患者生存时间的预后因素，具体信息仍然非常有限。本回顾性研究旨在评估并揭示胃中1/3腺癌可能的重要临床病理参数。
1986年至1992年间，本院有363例患者因原发性胃腺癌接受了胃切除术。其中52例（14.3%）患者纳入本研究，他们均符合以下标准：1）肿瘤主要位于胃中1/3，无远处转移或腹膜种植；2）接受根治性切除；3）至少接受R2淋巴结清扫。通过详细查阅病历和组织学切片获得临床病理结果。还联系了所有存活患者并记录了他们的当前状况。
总体5年生存率（Kaplan-Meier法）为42.5%。采用Kaplan-Meier法和长秩检验进行单因素生存分析时，浆膜侵犯（p<0.01）、淋巴结转移（p<0.01）和淋巴管受累（p<0.01）均具有个体预后意义。进行Cox比例风险回归多因素分析时，浆膜侵犯（P<0.01）和淋巴管受累（p<0.05）是仅有的两个与长期生存相关的独立预后因素。将这52例患者分为早期胃癌患者（n=10）和进展期胃癌患者（n=42）时，生存率之间存在显著差异（p<0.01）（90.0%对29.1%）。当将这些肿瘤进一步分为早期胃癌（n=10）、早期类似进展期胃癌（n=14）和Borrmann型进展期胃癌（n=28）时，早期胃癌（90.0%）与Borrmann型进展期胃癌（18.9%）之间、早期类似进展期胃癌（52.5%）与Borrmann型进展期胃癌（18.9%）之间的5年总生存率存在显著差异（分别为P<0.01和P<0.01）。国际抗癌联盟（UICC）分期对生存率也有显著影响（P<0.01）。
浆膜侵犯和淋巴管受累是预测胃中1/3腺癌患者生存率的重要独立预后因素。由于更晚期的肿瘤通常预后较差，早期检测对于提高生存率至关重要。
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