一家医院胃癌外科治疗疗效20年之变迁

Changes in clinicopathological features and survival after surgical resection for gastric cancer over a 20-year period at a single institution

目的探讨20年来胃癌临床病理特征及外科治疗效果的变迁。方法回顾性分析中山大学肿瘤防治中心1990年1月至2009年12月期间行胃癌手术切除的2518例患者的临床病理资料，将其按入院时间段分为前阶段组（1990-1999年）和近阶段组（2000-2009年），比较两组患者的临床病理特征及生存差异。结果全组患者5年生存率为48．1％，其中行根治性切除患者5年生存率为53．7％。前阶段组与近阶段组患者肿瘤大小、病理类型、脉管癌栓、T分期、N分期、TNM分期和淋巴结清扫数目的差异有统计学意义（均P〈0．05）。对于根治性切除患者，近阶段组平均清扫淋巴结数目为（20．1±8.3）枚／例，明显多于近阶段组的（9．5±6．0）枚／例（P〈0．01）。前阶段组和近阶段组患者5年生存率分别为40．1％和51．5％，其中根治性切除患者5年生存率分别为45．7％和57．1％．差异均有统计学意义（均P〈0．05）。多因素预后分析证实，时间段是胃癌患者的独立预后因素（HR=0．763，95％CI：0．669～0．872）。结论与20世纪90年代相比，近10年来胃癌外科治疗效果得到了确切提高。

Objective To investigate changes in clinicopathologieal features and survival of patients with gastrectomy at a single institution in China. Methods From January 1990 to December 2009, clinicopathological data of 2518 cases of gastric cancer patients who underwent surgical resection in the Sun Yat-sen Uinversity Cancer Center were analyzed retrospectively. The overall survival rate was determined using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis by Cox proportional hazards model. Clinical features, pathological findings and survival differences were compared in this cohort between two consecutive periods（1990-1999 and 2000-2009）. Results The 5-year survival rates for the whole cohort and those undergoing radical resection was 48.1% and 53.7%, respectively. In the first period, the 5-year survival rate for the whole cohort and for patients undergoing radical resection was 40.1% and 45.7%. In the second period, the 5-year survival rates for whole cohort and for patients undergoing radical resection was 51.5% and 57.1%, respectively. For those who underwent radical resection, the mean number of lymph node dissection was significantly higher in the recent period （20.1±8.3 vs. 9.5±6.0, P〈0.01）. On multivariate analysis by means of the Cox proportional hazard model, age, location, tumor size, histological type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, number of retrieved lymph nodes, and treatment period were independent factors （P〈0.05）. The constitution, number of retrieved lymph nodes, and survival rate were all improved between the two intervals （P〈0.05）. Conclusion The overall survival rate has gradually increased in gastric cancer patients over the past 20 years.