胃癌ABC根治度与预后关系的评价

Relationship between extent of tumor resection and prognosis: an evaluation in 533 cases of gastric cancer

目的 使胃癌手术根治度的判定标准具体客观,对胃癌手术预后的判断具有可靠性和可信性。方法 采用日本胃癌规约12 版中对胃癌手术根治度划为A、B、C 的标准,对1980 年12 月～1990 年12 月间手术切除的533 例胃癌根治度与预后的关系进行评价。结果 A 根治度157 例,B 根治度209 例,C 根治度167 例,其5 年生存率分别为80-9 % 、34-9 % 和9-0 % 。在B 根治度中,淋巴结清除站数> 淋巴结转移站数(D> N) 的5 年生存率为48-0 % ,D= N 为22-4 % 。二者差异有显著性( P<0-05) 。在根治性胃切除时意外发生切缘癌残留,A、B 根治度下降至C 根治度者分别为6-0 % 和12-2 % 。结论 胃癌淋巴结清除的站数应大于淋巴结转移的站数,即D> N。术中应检查切除胃标本切缘距肿瘤缘的距离是否充分,以防止胃切缘癌残留。

Objective To evaluate prognosis of patients with stomach cancer based on the extent of tumor resection. Methods Five hundred and thirty three cases of gastric cancer resected from 1980 through 1990 were divided into 3 categories A, B, and C, in the order of decreasing completeness of tumor resection as set forth in the 12 th edition of “Rules for Gastric Cancer in Japan”. Results There were 157 cases in category A, 209 cases in category B and 167 cases in category C. Their survival rate was 80.9%, 34.9%, and 9%, respectively. In category A and B, the depth of tumor invasion and lymph node metastasis were the major factors affecting survival rate. In the presence of lymph node metastasis, prognosis was dependent on which station (D 1～D 3) of lymph nodes dissected. In category B, if dissection covered D 3 but metastasis was limited to Ⅰ or Ⅱ, the 5 year survival rate was 48%; if lymph node dissection performed was limited to the same station of lymph nodes where metastasis occurred, the 5 year survival rate dropped to 22.4% ( P <0.05). In case cancer left over at the cutting edge, the completeness of resection might drop from category A or B to C, and the 5 year survival rate correspondingly decreased to 6% and 12.2%, respectively. Conclusion In order to ensure completeness of tumor resection, lymph node station dissected should be farther than that with metastasis, and the distance between the tumor and the cutting edge should be long enough to prevent residual tumor left behind.