不同部位可根治性胃癌病理特征外科处理方式及预后因素比较

Comparison of clinicopathological features,surgical interventions and prognostic factors of resectable gastric cancer of different locations

目的比较不同部位可根治性胃癌的病理特征、外科处理方式及预后影响因素。方法中山大学附属第一医院胃肠胰外科对1999年8月至2006年3月诊治的356例临床病理数据完整、无远处转移、并接受根治手术的原发性非全胃癌,依肿瘤部位分为胃上部癌(U,96例)、胃中部癌(M,93例)、胃下部癌(L,167例)3组,对其临床病理特征、外科处理方式、预后影响因素进行分析比较。结果不同部位癌的肿瘤直径、浆膜浸润、淋巴结转移状况、TNM分期、组织分型、术前癌胚抗原(CEA)值等差异无统计学意义(P>0.05)。U、M、L部癌的中位生存期分别为49.0、70.1、70.9个月;U部癌预后差于其他组(P<0.05)。胃癌总体的独立预后因素包括术后病理分期(pTNM)、Borrmann分型、根治方式;U部癌的独立预后因素为pTNM、根治方式;M部癌的独立预后因素为pTNM、Borrmann分型;L部癌的独立预后因素为pTNM、根治方式。结论不同部位可根治性胃癌的病理特征、预后影响因素不同,外科处理方法应区别对待。

Objective To compare the clinicopathological features, surgical interventions and prognostic factors of resectable gastric cancer （GC） of different locations. Methods According to the lesion location, 356 cases of GC admitted between August 1999 and March 2006 at Gastric Cancer Center of Sun Yat-sen University were divided into 3 groups： upper tumor （U, 96 cases）, middle tumor （M, 93cases） and lower tumor （L, 167cases）. Their clinicopathological features, surgical interventions and prognostic factors were compared. Results There had no significant difference in tumor diameter, serosal infiltration （macroscopic observation）, number of positive lymph nodes, TNM staging, histologic type, preoperative level of CEA among the three groups （P〉0.05）. The mean survival time in U, M, L was 49.0, 70.1, 70.9 months respectively. The prognosis of U was poorer than those of the other two groups. The independent prognostic factors of all cases included pTNM staging, Borrmann type, extent of lymphadenectomy. The pTNM staging and extent of lymphadenectomy were independent prognostic factors in U and L, while pTNM staging, Borrmann type in M. Conclusion The clinicopathological features and prognostic factors of resectable gastric cancer of different location are different. So gastric cancer of different locations should be treated with different surgical interventions.