残胃癌的临床病理特点及预后分析

Clinicopathologic features and prognostic outcomes of patients with remnant gastric cancer

目的许多学者认为残胃癌切除率低,预后不佳。本研究通过与近端胃癌对比,了解胃良性疾病术后残胃癌的临床病理特点及预后。方法回顾性分析1998～2008年间在我院施行手术的胃癌患者,其中残胃癌31例,近端胃癌144例,分析两组患者的临床病理特点、患者预后及影响预后的因素。结果初次胃切除术后至确诊残胃癌的平均间隔时间为(16.87±4.30)年,残胃癌多位于吻合口(87.1%)。与近端胃癌的患者相比,残胃癌患者的平均年龄较大,但肿瘤大小、分期、组织分型、浸润深度、淋巴转移、远处转移等临床病理特点及根治切除率均无显著性差异。残胃癌总体5年生存率为29.1%,与近端胃癌的39.7%无显著性差异(P﹥0.05)。根治手术的残胃癌患者5年生存率为38.3%,与近端胃癌差异无统计学意义。浸润深度和根治手术是本组残胃癌患者的独立预后因素。结论残胃癌的临床病理特点及预后与近端胃癌相似。早期诊断、接受根治手术,可有效改善残胃癌患者的预后。

Objective The prognosis of patients with remnant gastric cancer was considered to be poor because of low resectability.The objective of this study was to evaluate clinicopathologic features and prognostic outcomes of patients with remnant gastric cancer compared with upper one-third cancer of the stomach. Methods There were 31 patients with remnant gastric cancer and 144 patients with primary upper one-third cancer of the stomach who underwent surgery in our hospital from 1998 to 2008. Clinicopathologic characteristics and prognostic factors were compared between the two groups. Results The mean interval between previous gastrectomy for benign diseases and diagnosis of remnant gastric cancer was(16.87±4.30)years. The majority (87.1%) of remnant gastric cancer occurred at the stomas. The average age of the patients with remnant primary gastric cancer was (64.48±8.58)years, significantly older than(58.68±10.06) years of those with upper one-third gastric cancer. There were no significant differences in clinicopathlogic characteristics such as tumor size, stage, histology, tumor depth, lymph nodes involvement, distant metastasis as well as radical resectability between the two groups. The overall 5-year survival rate of the patients with remnant gastric cancer was similar to those with upper one-third gastric cancer (29.1% vs.39.7%,P>0.05). Tumor depth and radical resection were independent prognostic factors for those with remnant gastric cancer. Conclusions The clinicopathologic features and prognostic outcomes of patients with remnant gastric cancer are similar to those with upper one-third gastric cancer. Early diagnosis and radical resection may improve the prognosis in remnant gastric cancer.