残胃癌的临床病理特征及预后分析

Clinicopathological characteristics and prognosis of gastric remnant cancer

目的 :探讨残胃癌的临床病理特征、预后及其影响因素。方法 :2003年1月—2012年12月,上海交通大学医学院附属仁济医院共收治残胃癌患者85例,回顾性分析其中行手术切除治疗的58例残胃癌患者的临床病理资料及预后影响因素。结果 :残胃癌患者占同期胃癌患者的1.5%,男性多于女性,男女之比为4.3∶1,中位年龄为70岁。与首次疾病为胃癌的患者相比,首次疾病为消化性溃疡的患者,首次手术时行BillrothⅡ式吻合术的比例较高(分别为73.8%和37.5%,P=0.010),术后至残胃癌确诊的时间间隔更长(分别为29.2±10.6和12.7±12.9年,P=0.000)。与BillrothⅠ式吻合术相比,首次手术为BillrothⅡ式吻合术的患者,其吻合口残胃癌的发生率更高(分别为73.0%和28.6%,P=0.001)。肿瘤大体分型为BorrmannⅣ型者的肿瘤直径较大,未分化型所占比例较高,并且更易发生在全残胃。残胃癌患者的手术切除率和根治性切除率分别为68.2%(58/85)和55.3%(47/85)。47例根治性切除患者的1、3和5年生存率分别为70.2%、38.4%和32.4%。单因素分析结果显示,肿瘤部位、肿瘤分化程度、肿瘤直径、贫血、血清癌胚抗原水平、肿瘤侵犯深度、淋巴结转移、远处转移、TNM分期、手术根治情况、联合脏器切除和Borrmann分型是残胃癌手术切除患者预后的影响因素(P值均<0.05)。多因素分析结果显示,肿瘤分化程度、贫血、血清癌胚抗原水平和远处转移是预后的独立影响因素(P值均<0.05)。结论 :残胃癌预后的相关因素包括肿瘤分化程度、贫血、血清癌胚抗原水平和远处转移。无论是消化性溃疡还是胃癌的胃大部切除术后,定期复查不仅可以监测残胃癌的发生,还可以评估残胃癌患者的预后。

Objective： To explore the clinicopathological characteristics of gastric remnant cancer （GRC） and identify its prognostic factors. Methods： From January 2003 to December 2012, 85 patients with gastric remnant cancer were treated in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The medical records of 58 patients who underwent surgical resection were retrospectively analyzed. Results： The patients with GRC accounted for 1.5% of the patients with gastric cancer during the same period. GRC was likely to develop in males, and the ratio of males to females was 4.3：1. The median age was 70 years old. As compared to patients with previous gastric cancer, Billroth II reconstruction was more common in patients with previous peptic ulcer （73.8% vs 37.5%; P = 0.010）. The interval time from first surgical resection to diagnosis of GRC was longer in cases of previous peptic ulcer than in cases of previous gastric cancer （29.2±10.6 vs 12.7±12.9 years; P = 0.000）. Tumors located in anastomotic sites were more common in Billroth Ⅱ reconstruction than in Billroth I reconstruction （73.0% vs 28.6%; P = 0.001）. Borrmann type Ⅳ cancers had a high incidence of larger tumor size, undifferentiated pathology and diffuse tumor in whole gastric remnant. The resection and radical resection rates of GRC were 68.2% （58/85） and 55.3% （47/85）, respectively. The overall 1-, 3-, and 5-year survival rates of patients who underwent radical resection were 70.2%, 38.4% and 32.4%, respectively. Univariate analysis showed that the significant factors affecting survival included tumor location, differentiation, tumor diameter, anemia, serum carcino-embryonic antigen （CEA） level, depth of invasion, nodal metastasis, distant metastasis, TNM stage, curability, resection combined with organs, and Borrmann type （all P 〈 0.05）; whereas differentiation, anemia, serum CEA level and distant metastasis were independent prognostic factors in multivariable analysis （all P 〈 0.05）. Conclusion： The factors influencing the prognosis of GRC include differentiation, anemia, serum CEA level and distant metastasis, Regular follow-up is essential for monitoring the occurrence and evaluating the prognosis of GRC after gastrectomy, regardless of peptic ulcer or gastric cancer.