残胃癌的临床病理学特征分析(附114例报道)

Analyses of Clinicopathologic Characteristics for Remnant Gastric Cancer

目的总结分析残胃癌的临床病理学特征。方法回顾性分析2000年3月至2008年5月期间川北医学院附属第二医院和中国人民解放军总医院共114例残胃癌的临床病理学资料。依据原发疾病性质分为良性疾病组和恶性疾病组进行分析。结果本组114例患者,年龄(62.6±11.3)岁,男∶女=4.7∶1.0。76.2%(64/84)的患者诊断时处于进展期(以pT分期为依据),pT1期病例仅占23.8%(20/84),60.7%(51/84)的病例达pT4期。残胃癌的一般病理特征:pT4b(27.4%,23/84)、pN+(42.9%,36/84)及cM1(27.2%,31/114)常见,93.5%(29/31)的远处转移位于腹腔,腹膜转移最高达67.7%(21/31)。组织学分化程度以低分化腺癌最常见(76.7%,79/103),Laurén分型以弥漫型最常见(78.6%,81/103)。良、恶性原发疾病间首次采用的手术方式和重建方式差异均有统计学意义(均P=0.000)。中位发病时间(潜伏期)良性组∶恶性组=30.0年∶3.3年(P=0.000),主要受原发疾病性质、首次手术时年龄的影响(P<0.05)。良、恶性组间的病理学指标比较,除是否为印戒细胞癌(P=0.045)、是否侵犯周围脏器(P=0.049)、pN分期(P=0.025)及Borrmann分型(P=0.005)差异有统计学意义外,其余病理学指标以及手术切除率、R0切除率和生存率差异均无统计学意义(P>0.05)。结论残胃癌的主要临床病理学特征基本上不受原发疾病性质的影响,建立个体化的内镜随访程序是必要和可行的。

Objective To analyze the clinicopathologic characteristics of remnant gastric cancer（RGC）.Methods The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively.The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated.Results A total of 114 cases,the age was（62.6±11.3）years,and the males versus females was 4.7∶1.0.Most patients（76.2%,64/84）were diagnosed at advanced stages（consistent with pT）,and the proportion of pT1 stage cases was only 23.8%（20/84）,tumor invasion pT4 was 60.7%（51/84）.It was more common that tumor directly invaded adjacent organs or structures（27.4%,23/84）,lymph nodes positive（42.9%,36/84）,and distant metastasis（27.2%,31/114）.The location of distant metastasis was usually confined in the abdominal cavity（93.5%,29/31）,and the peritoneum disseminated was the most commonly structures（67.7%,21/31）.Histologically,the incidence of poorly differentiated adenocarcinoma（76.7%,79/103）was the mostly histologic grade as well as the diffuse type（78.6%,81/103）was the mostly Laurén classification.Between the patients with primary benign diseases and those with initial malignant disease,the initial gastrectomy or the methods of reconstruction had significantly differences（both P=0.000）.The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease,contrary to 3.3 years in those with previous malignant disease（P=0.000）.Both primary diseases（benign or malignant）and the age at initial gastrectomy were the major influencing factors for the time of RGC developed（P0.05）.For pathohistology characters,except signet-ring cell carcinoma（P=0.045）,pT4b（P= 0.049）,pN stage（P=0.025）,and Borrmann classification（P=0.005）,there were no significant differences between the patients with previous benign diseases and those with original malignant disease,as well as the resectability rate,curative resection（R0）rate,and overall survival rate（P 0.05）.Conclusions It is almost unaffected by original benign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.