胃癌根治术后切端癌残留的预后及化学治疗效果

Prognosis of Gastric Cancer after Radical Gastrectomy with Residual Positive Margin and Outcome of Adjuvant Chemotherapy

目的：了解胃癌根治术后切端癌残留对预后的影响及术后化疗是否能提高其生存率。方法：对70 例胃癌根治术后切端癌残留病例及1 073 例无癌残留病例回顾性分析及随访结果。结果：远侧胃大部切除术后切端阳性与切端阴性者总5年生存率分别为12．5％、38．2％（P＜0．05）近端胃大部切除术后切端阳性与切端阴性5年生存率分别为13．0％、25．5％（P＜0．05)。但按分期比较，则各期5年生存率切端阳性与切端阴性均无显著性差异（P＞0．05)。而术后化疗者5年生存率为20．0％，未化疗者为0，二者有显著性差异（P＜0．05)。结论：胃癌术后切端癌残留者预后差，术后化疗可提高切端癌残留者的5 年生存率，特别是Ⅲ期患者。

Objective To study the prognosis of patients with residual cancer at the resected margin after radical gastrectomy for gastric cancer and the outcome of chemotherapy． Methods Seventy patients with positive margin and 1 073 patients with negative margin after gastrectomy for gastric cancer were analyzed retrospectively． Results The overall 5－year survival rate for patients with positive and negative margin after distal gastrectomy were 12．5％ and 38．2％ respectively (P＜0．05) and 13．0％ and 12．5％ for patients after proximal gastrectomy respectively (P＜0．05) but for stage Ⅱ～Ⅳ tumor there was no difference of 5－year survival rate between the positive margin group and negative margin group． The 5－year survival rate was 20％ for cases with postoperative chemotherapy and 0％ for cases without postoperative chemotherapy the difference between them was remarkable (P＜0．05)． Conclusion Residual cancer at the resected margin is not a significant prognostic factor for patients underwent gastrectomy for gastric cancer． Postoperative chemotherapy can improve the 5－year survival rate for patients with positive margin．