胃裸区对胃底贲门癌预后的临床价值

Clinical value of gastric bare area for the prognosis of gastric fundus and cardia carcinoma

目的探讨胃裸区（GBA）对胃底贲门癌患者预后的临床价值。方法回顾性分析2010年1月至2011年12月手术治疗的82例胃底贲门癌患者的临床资料，将患者根据肿瘤是否累及GBA分为两组，A组49例肿瘤累及GBA，B组33例肿瘤未累及GBA。所有患者均行D2近端胃癌根治术加胃裸区清扫，术后采用FOLFOX-4方案规律化疗6个周期。对A、B两组患者进行术后随访和生存分析。结果生存分析显示A组患者术后1、2、3年累积生存率分别为91．8％、57．3％、29．0％，B组患者分别为93．9％、75．0％、48．2％。A、B两组患者术后中位生存时间分别为27．0、36．0个月，差异有统计学意义（x2=4．972，P=0．026）。结论胃底贲门癌累及GBA的患者预后较差，GBA清扫可能有助于改善胃底贲门癌患者的预后。

Objective To explore the clinical value of gastric bare area （GBA） for the prognosis of gastric fundus and cardia carcinoma. Methods The data of 82 patients with gastric fundus and cardia carcinoma from January 2010 to December 2011 were retrospectively analyzed. The patients were divided into group A （49 cases） with cancer cell invasion in GBA and group B （33 cases） without invasion in GBA. All the patients underwent D2 gastrectomy plus surgical resection of GBA and were treated by 6 cycles of postoperative FOLFOX-4 chemotherapy scheme. Postoperative follow-up and survival analysis were carried out for patients in both groups. Results According to survival analysis （Kaplan-Meier method）, the postoperative 1-, 2- and 3-year cumulative survival rates of the patients in group A were 91.8 %, 57.3 % and 29.0 %, respectively, while those of the patients in group B were 93.9 %, 75.0 % and 48.2 %, respectively. The median survival times of the patients in group A and group B were 27.0 months and 36.0 months, respectively, which was demonstrated existing statistical significance（X2 = 4.972, P = 0.026）. Conclusions The prognosis of gastric fundus and eardia carcinoma patients with invasion in GBA by cancer cells is poor. Surgical resection of GBA may help to improve the prognosis of the patients with gastric fundus and cardia carcinoma.