非根治性肿瘤切除术在胃癌伴单纯腹膜转移中的作用

Benefit of non-curative resection on gastric cancer patients with peritoneal metastasis

目的:探讨非根治性肿瘤切除术在胃癌伴单纯腹膜转移中的作用及其对病人预后的影响。方法:回顾性研究2006年至2009年经术中探查诊断为胃癌伴单纯腹膜转移的119例胃癌病人。其中63例行非根治性肿瘤切除术,56例未行肿瘤切除术。对两组以及3个亚组病人进行临床病理资料的比较及生存分析。结果:非根治性肿瘤切除组中病人总的平均生存时间要长于未行肿瘤切除组(14.8±1.8个月比7.7±0.8个月,P=0.001)。在亚组分析中发现,在P1或P2腹膜转移的胃癌病人中,非根治性肿瘤切除组的平均生存时间要显著长于未行肿瘤切除组(21.1±3.0个月比7.6±0.9个月,P=0.001),而两组中的P3腹膜转移的胃癌病人间无统计学差异(P=0.489)。多因素生存分析显示,只有非根治性肿瘤切除是P1或P2腹膜转移胃癌病人的独立预后指标(r=4.988,P=0.001),且两组之间的围手术期死亡率并无统计学差异(P=0.747)。结论:非根治性肿瘤切除术能延长胃癌伴单纯P1或P2腹膜转移病人的预后,而P3腹膜转移的胃癌病人不建议接受此类手术治疗。

Objective To evaluate the benefit of non-curative resection on gastric cancer patients with peritoneal metastasis. Methods From 2006 to 2009, 119 gastric cancer patients with peritoneal metastasis were identified during operation. Sixty-three of them underwent non-curative resection and the remaining 56 patients underwent non-resection. The clinicopathological data and survival were analyzed. Results The overall survival was longer in non-curative resection group than in non-resection group （14.8±1.8 months vs 7.7±0.8 months, P=-0.001）. Subgroup analysis of the P1/Pz patients showed that the survival was significantly longer in patients with non-curative resection than non-resection （mean survival time 21.1±3.0 months vs 7.6±0.9 months, P=-0.001）, but no difference in P3 group （P=-0.489）. Multivariate analysis indicated that only non-curative resection was associated with better prognosis in P1/Pz patients. Peri-operative mortality in non-curative resection group was similar with that in non-resection group（P=0.747）. Conclusions Non-curative resection can prolong the survival of gastric cancer patients with PJ/P2 peritoneal metastasis. However, this surgical approach is not recommended for P3 gastric cancer patients.