Grisé K, McFadden D
Department of Surgery, University of California at Los Angeles Medical Center, 90095, USA.
Am Surg. 1998 Oct;64(10):930-3.
Hospital records of all 277 patients who underwent surgery for gastric adenocarcinoma at the University of California at Los Angeles Medical Center from 1970 through 1996 were reviewed. Patients were stratified into three groups comprising 1970 to 1979, 1980 to 1989, and 1990 to 1996. The incidence of stage IV disease decreased by 50 per cent over the course of the study (P < 0.001). Lymph node involvement declined by 30 per cent (P < 0.01). Endoscopy displaced contrast radiography as the primary diagnostic modality. Sensitivity of endoscopic biopsy averaged 92 per cent. Twice as many patients were resected for cure in the current decade compared with the 1970s (P < 0.001). Operative mortality was less than 2.5 per cent for the entire period studied and has been nil in the 1990s. Intraoperative blood loss and transfusion requirements also decreased significantly each decade. Hospital stay was shortened by 41 per cent and the length of postoperative stay in the intensive care unit decreased from a median of 4 days to zero. Five-year survival improved significantly during the study period, mirrored by an increase in survival for early cancers. We have found an earlier presentation of gastric adenocarcinoma over the past 3 decades that parallels an increased use of endoscopy and an improved sensitivity of endoscopic biopsy. More patients are now resectable than in previous decades. Survival after surgical treatment of gastric adenocarcinoma improved between 1970 and 1996, partially due to an increase in earlier stage lesions. Improved survival is also demonstrable when only early stage cancers are considered.
对1970年至1996年在加利福尼亚大学洛杉矶分校医学中心接受胃腺癌手术的所有277例患者的医院记录进行了回顾。患者被分为三组，分别为1970年至1979年、1980年至1989年和1990年至1996年。在研究过程中，IV期疾病的发病率下降了50%（P<0.001）。淋巴结受累率下降了30%（P<0.01）。内镜检查取代了造影检查成为主要诊断方式。内镜活检的敏感性平均为92%。与20世纪70年代相比，当前十年接受根治性切除的患者数量增加了一倍（P<0.001）。在整个研究期间，手术死亡率低于2.5%，在20世纪90年代为零。每十年术中失血量和输血需求量也显著下降。住院时间缩短了41%，重症监护病房的术后住院时间从中位数4天降至零。在研究期间，五年生存率显著提高，早期癌症生存率的增加反映了这一点。我们发现在过去三十年中，胃腺癌的就诊时间更早，这与内镜检查的使用增加和内镜活检敏感性的提高相平行。现在可切除的患者比前几十年更多。1970年至1996年期间，胃腺癌手术治疗后的生存率有所提高，部分原因是早期病变的增加。仅考虑早期癌症时，生存率的提高也很明显。
