Sánchez-Bueno F, Garcia-Marcilla J A, Perez-Flores D, Pérez-Abad J M, Vicente R, Aranda F, Ramirez P, Parrilla P
Department of General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
Br J Surg. 1998 Feb;85(2):255-60. doi: 10.1046/j.1365-2168.1998.00558.x.
Gastric cancer has a poor prognosis. The aim of this study was to determine the influence of several clinicopathological variables on outcome in a series of 297 Western patients undergoing surgical resection for gastric adenocarcinoma.
The results were analysed retrospectively and prognostic factors were identified in a univariate and Cox proportional hazards regression model. Mean patient age at the time of operation was 61.9 years; 65.7 per cent were men. Mean follow-up was 7.8 (range 1-15) years. Of the 297 patients undergoing surgery, 70 per cent had subtotal gastrectomy, 26.3 per cent underwent total gastrectomy and 3.7 per cent had proximal gastrectomy.
The overall survival rate was 38.9 per cent at 5 years. In th univariate analysis, survival-related factors were weight loss (P < 0.05), abdominal mass (P < 0.01), dysphagia (P < 0.001), type of gastrectomy (subtotal gastrectomy versus total gastrectomy, P < 0.001), intention of resection (curative versus palliative resection, P < 0.001), tumour site (P < 0.001), histopathological grade (low versus high grade, P < 0.05), tumour diameter less than 3 cm (P < 0.001), degree of gastric wall invasion (P < 0.001), degree of lymph node invasion (P < 0.001) and stage of the neoplasia (P < 0.001). Other variables had no significant influence. In the multivariate analysis, degree of gastric wall invasion, lymph node invasion, tumour size and dysphagia at presentation were the only independent prognostic variables.
From these data it was possible to derive a prognostic index with which patients could be classified as at low, intermediate or high risk.
胃癌预后较差。本研究旨在确定一系列297例行胃腺癌手术切除的西方患者中，若干临床病理变量对预后的影响。
对结果进行回顾性分析，并在单变量和Cox比例风险回归模型中确定预后因素。手术时患者的平均年龄为61.9岁；65.7%为男性。平均随访时间为7.8年（范围1 - 15年）。在297例接受手术的患者中，70%接受了胃大部切除术，26.3%接受了全胃切除术，3.7%接受了近端胃切除术。
5年总生存率为38.9%。在单变量分析中，与生存相关的因素有体重减轻（P < 0.05）、腹部肿块（P < 0.01）、吞咽困难（P < 0.001）、胃切除术类型（胃大部切除术与全胃切除术，P < 0.001）、切除意图（根治性与姑息性切除，P < 0.001）、肿瘤部位（P < 0.001）、组织病理学分级（低级别与高级别，P < 0.05）、肿瘤直径小于3 cm（P < 0.001）、胃壁侵犯程度（P < 0.001）、淋巴结侵犯程度（P < 0.001）和肿瘤分期（P < 0.001）。其他变量无显著影响。在多变量分析中，胃壁侵犯程度、淋巴结侵犯、肿瘤大小和就诊时的吞咽困难是仅有的独立预后变量。
根据这些数据，可以得出一个预后指数，据此可将患者分为低、中或高风险。
