残胃癌的外科治疗与预后分析

Surgical treatment and prognosis of gastric stump cancer

背景与目的:残胃癌具有独特的生物学活性,外科治疗复杂,预后差。本研究主要探讨残胃癌的临床特点、治疗方法对远期生存率的影响,分析影响预后的因素。方法:回顾性分析浙江省肿瘤医院1990年1月至2007年12月收治的81例残胃癌的临床资料。用Kaplan-Meier法进行生存分析,用Cox回归模型进行多因素分析。结果:81例残胃癌中,根治性手术切除治疗47例,非根治性治疗(包括姑息性切除术、短路或造瘘术及探查术)34例,根治手术切除率为58.0%。全组1、3、5年总生存率分别为69.1%、24.3%、11.8%。根治组患者1、3、5年生存率分别为93.6%、42.0%、20.8%,非根治组1、3、5年生存率分别为35.3%、5.9%、0%,两组相比差异有统计学意义(P<0.05)。Cox多元回归分析显示,残胃癌术后生存率与肿瘤的病理类型、病期、根治情况、腹膜种植、肝转移等因素有关。结论:合理的根治性手术可提高残胃癌患者的生存率。肿瘤的病理类型、TNM分期、根治情况、腹膜种植、肝转移是影响预后的独立因素。

Background and Objective. Gastric stump cancer （GSC） has unique biological behaviors and poor prognosis. The surgical treatment for GSC is complex. This study was to explore the clinical characteristics of GSC and the effect of operation patterns on long-term survival, and investigate its prognostic factors. Methods. The clinical data of 81 GSC patients, treated in Zhejiang Cancer Hospital from January 1990 to December 2007, were analyzed. Patients＇ survival was analyzed by Kaplan-Meier method~ the prognosis was analyzed by Cox multivariate regression model. Results： Of the 81 patients, 47 （58.0%） received radical resection, 34 received non-radical operation （including palliative operation, short circuit or fistulation and exploration）. The overall 1-, 3-, and 5-year survival rates were 69.1%, 24.3%, and 11.8% in the whole group. The 1-, 3-, and 5-year survival rates were significantly higher in radical resection group than in non-radical operation group （93.6% vs. 35.3%, 42.0% vs. 5.9%, 20.8% vs. 0, P〈0.05）. Cox multivariate regression analysis showed that clinical stage, pathologic classification, radical resection, peritoneal seeding and liver metastasis were related with the survival of GSC patients. Conclusions： Radical resection may help to improve the prognosis of GSC. Clinical stage, pathologic classification, radical resection, peritoneal seeding and liver metastasis are independent prognosis factors of GSC.