Subtotal gastrectomy combined with chemotherapy: An effective therapy for patients with circumscribed Borrmann type Ⅳ gastric cancer

BACKGROUND Although Borrmann type Ⅳ(B-4) gastric cancer has a higher mortality rate and presents distant metastasis easily, especially peritoneal metastasis, when diagnosed, some B-4 patients were found to have no distant metastasis by preoperative detection and underwent curative surgery, which was defined as circumscribed B-4 in our study. In this study, we focused on the circumscribed B-4 patients without distant metastasis during surgery to identify factors related to prognosis and postoperative peritoneal cavity metastasis(PPCM), which is important for selecting an appropriate therapeutic strategy.AIM To identify factors related to the prognosis and PPCM of B-4 patients.METHODS A total of 117 B-4 patients who underwent gastrectomy between January 2005 and December 2012 were included in this study. Survival analysis was performed using Kaplan–Meier analysis and Cox multivariate models. Pearson correlation analyses were performed to identify the factors related to PPCM. All statistical analyses were performed using SPSS 20.0.RESULTS Lymph node status, gastrectomy type, and postoperative chemotherapy were independent prognostic factors in 117 circumscribed B-4 patients. Subtotal gastrectomy combined with chemotherapy could significantly improve the longterm survival time. Six patients who were diagnosed with pN0 and received the combination therapy had a 3-year survival rate of 100% and a median survival of 77.7 mo. Even for patients with metastatic lymph nodes(n = 13), the combination therapy also increased the 3-year overall survival rate to 57.1%. In addition, positive lymph node status was the only factor(P = 0.005) correlated with PPCM in certain B-4 patients, and chemotherapy was useful for suppressing PPCM in patients with subtotal gastrectomy but not in those with total gastrectomy.CONCLUSION Lymph node status is an independent prognostic factor for circumscribed B-4 patients. In addition, subtotal gastrectomy and postoperative chemotherapy could effectively improve prognosis and even suppress PPCM.

Prognostic significance of Borrmann type combined with vessel invasion status in advanced gastric cancer

BACKGROUND Borrmann classification(types I-IV)for the detection of advanced gastric cancer has been accepted worldwide,and lymphatic and/or blood vessel invasion(LBVI)status is related to the poor prognosis after gastric cancer.AIM To evaluate the significance of Borrmann type combined with LBVI status in predicting the prognosis of advanced gastric cancer.METHODS We retrospectively studied the clinicopathological characteristics and long-term survival data of 2604 patients who were diagnosed with advanced gastric adenocarcinoma at Harbin Medical University Cancer Hospital from January 2009 to December 2013.Categorical variables were evaluated by the Pearson’sχ^2 test,the Kaplan-Meier method was used to identify differences in cumulative survival rates,and the Cox proportional hazards model was used for multivariate prognostic analysis.RESULTS A total of 2604 patients were included in this study.The presence of LVBI[LBVI(+)]and Borrmann type(P=0.001),tumor location(P<0.001),tumor size(P<0.001),histological type(P<0.001),tumor invasion depth(P<0.001),number of metastatic lymph nodes(P<0.001),and surgical method(P<0.001)were significantly correlated with survival.When analyzing the combination of the Borrmann classification and LBVI status,we found that patients with Borrmann type Ⅲ disease and LBVI(+)had a similar 5-year survival rate to those with Borrmann IV+LBVI(-)(16.4%vs 13.1%,P=0.065)and those with Borrmann IV+LBVI(+)(16.4%vs 11.2%,P=0.112).Subgroup analysis showed that the above results were true for any pT stage and any tumor location.Multivariate Cox regression analysis showed that Borrmann classification(P=0.023),vascular infiltration(P<0.001),tumor size(P=0.012),pT stage(P<0.001),pN stage(P<0.001),and extent of radical surgery(P<0.001)were independent prognostic factors for survival.CONCLUSION Since patients with Borrmann Ⅲ disease and LBVI(+)have the same poor prognosis as those with Borrmann IV disease,more attention should be paid to patients with Borrmann Ⅲ disease and LBVI(+)during diagnosis and treatment,regardless of the pT stage and tumor location,to obtain better survival results.

Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer

BACKGROUND The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer,and Borrmann typeⅣdisease is independently associated with a poor prognosis.AIM To evaluate the prognostic significance of lymphatic and/or blood vessel invasion(LBVI)combined with the Borrmann type in advanced proximal gastric cancer(APGC).METHODS The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.RESULTS In these 440 patients,LBVI+status was associated with Borrmann typeⅣ,low histological grade,large tumor size,and advanced pT and pN status.The 5-year survival rate of LBVI+patients was significantly lower than that of LBVI– patients,although LBVI was not an independent prognostic factor in the multivariate analysis.No significant difference in the prognosis of patients with Borrmann typeⅢ/LBVI+disease and patients with Borrmann typeⅣdisease was observed.Therefore,we proposed a revised Borrmann typeⅣ(r-BorⅣ)as Borrmann typeⅢplus LBVI+,and found that r-BorⅣwas associated with poor prognosis in patients with APGC,which outweighed the prognostic significance of pT status.CONCLUSION LBVI is related to the prognosis of APGC,but is not an independent prognostic factor.LBVI status can be used to differentiate Borrmann typesⅢandⅣ,and the same approach can be used to treat r-BorⅣand Borrmann typeⅣ.

Safety and efficacy of a programmed cell death 1 inhibitor combined with oxaliplatin plus S-1 in patients with Borrmann large type III and IV gastric cancers

BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.

超声内镜和多层螺旋CT对BorrmannⅣ型胃癌术前分期的比较研究

目的对超声内镜(EUS)和多层螺旋CT(MSCT)检查在BorrmannⅣ型胃癌术前分期中的作用进行比较。方法回顾性分析48例BorrmannⅣ型胃癌患者的影像学术前TNM分期,并与术后病理分期进行比较。结果 EUS和MSCT检查对T分期的准确率分别为54.2%和79.2%(P=0.009),分层分析表明MSCT对T3、T4分期的准确率高于EUS(T3:84.6%vs 57.7%,P=0.032;T4:82.4%vs 41.2%,P=0.032)。两者对N分期的准确率,均为56.3%(P=1.000),无明显差异,EUS和MSCT对淋巴转移检查的特异度和灵敏度分别为83.3%/72.2%和66.7%/91.7%。结论 EUS更适合对早期胃癌分期,而已浸润至浆膜层及有远处转移的BorrmannⅣ型胃癌患者,应优先选择MSCT检查进行分期。

Borrmann4型胃癌病理学及免疫组织化学研究

回顾性统计学分析１２７例Ｂｏｒｒｍａｎｎ４型胃癌临床病理特点及影响预后的因素，发现组织学类型及间质淋巴细胞浸润程度对预后影响最大。并采用免疫组织化学（ＡＢＣ法）技术对正常胃粘膜５４例、Ｂｏｒｒｍａｎｎ２型胃癌２５例、Ｂｏｒ－ｒｍａｎｎ４型胃癌２３例的冰冻组织切片进行了染色。结果表明：细胞纤维粘连蛋白及基底膜纤维粘连蛋白、层粘连蛋白在上述组织之间呈递减趋势，在Ｂｏｒｒｍａｎｎ４型胃癌中减少乃至消失。它们的表达与癌的浸润转移密切相关。

超声定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断价值的探讨

目的:探讨超声内镜定位下凿洞式深挖活检对BorrmannⅣ型胃癌诊断的价值。方法:回顾性分析病理确诊的53例BorrmannⅣ型胃癌的临床资料,比较常规活检及超声内镜定位下凿洞式深挖活检对BorrmannⅣ型胃癌的诊断结果。结果:常规胃镜首次活检诊断BorrmannⅣ型胃癌阳性率30.2%(16/53),活检阴性患者多次重复活检阳性率13.5%(5/37),常规内镜活检总阳性率为39.6%(21/53)。46例BorrmannⅣ型胃癌患者行超声内镜检查,诊断与病理符合率为95.5%(44/46)。21例多次活检阴性患者行超声内镜定位下凿洞式深挖活检,术后标本送病理检查阳性率61.9%(13/21)。仅2例患者活检后创面少量渗血,所有患者术后观察无出血、穿孔等并发症发生。结论:超声内镜定位下凿洞式深挖活检显著提高BorrmannⅣ型胃癌临床内镜活检阳性率,为BorrmannⅣ型胃癌的诊断提供了更有效的病理确诊依据。该操作安全性高,费用少,值得临床推广。

Borrmann Ⅳ型胃癌18例误诊分析

目的分析BorrmannⅣ型胃癌的临床特点、误诊原因及防治策略。方法回顾性分析1996年1月-2013年1月南昌解放军第94医院肿瘤科经病理学证实的BorrmannⅣ型胃癌误诊患者18例临床资料,并复习相关文献。结果 BorrmannⅣ型胃癌患者18例中男7例,女11例,年龄30~71岁;病程1周~3个月,均曾接受1~2次胃镜检查。误诊为慢性胃炎7例,消化性溃疡6例,结核性腹膜炎2例,卵巢癌3例。18例经上消化道造影或腹部CT检查和体检提示有异常,再次行胃镜检查或手术而确诊,其中中分化腺癌1例,低分化腺癌6例,黏液腺癌2例,印戒细胞癌6例,未分化癌3例。接受胃癌姑息性手术9例,行卵巢转移癌姑息性手术2例,行全身化疗和腹腔灌注化疗12例。最长生存期为23个月,9例生存期不超过1年。结论胃镜联合上消化道造影、腹部CT和超声内镜检查可提高BorrmannⅣ型胃癌的检出率,以手术为主的综合治疗可改善患者生存期。

220例BorrmannⅣ型胃癌临床病理特征分析

目的探讨Borrmann Ⅳ型胃癌的临床病理特点。方法整群选取并回顾性探讨中山大学肿瘤防治中心2000—2010年220例Borrmann Ⅳ型胃癌的临床资料,将年龄、性别、家族史、手术切除率、周围脏器侵犯、浆膜受侵、腹膜种植、肝脏转移、腹水、术后并发症、病理类型、p TNM分期等临床病理参数与同期其他Borrmann分型胃癌对比。比较Borrmann Ⅳ型胃癌在同期胃癌中的构成比。临床病理参数的对比用χ^2检验;生存状况的比较采用寿命表法。结果Borrmann Ⅳ型胃癌和其他Borrmann分型胃癌的临床病理参数差异有统计学意义（P〈0.05）;生存分析显示,非Borrmann Ⅳ型胃癌的1、3、5年生存率分别为58%、44%、38%,而Borrmann Ⅳ型胃癌仅有24%、11%、10%（P=0.000）,差异有统计学意义。结论 Borrmann Ⅳ型胃癌呈现高恶性度的生物学特点：分化不良、淋巴结转移率高、容易出现腹膜转移、浆膜受侵,周围脏器侵犯严重,p TNM分期晚,手术切除率低,预后极差。

BorrmannⅣ型胃癌超声内镜诊断价值的研究

目的:评价超声内镜(EUS)对 BorrmannⅣ型胃癌的诊断效果。材料与方法:138例胃癌病例术前均经内镜和病理活检检查。其中36例胃镜疑为 BorrmannⅣ型胃癌的病例术前同时做了 EUS 检查,结果与术后外科病理诊断进行对照。结果:胃镜检出的138例胃癌中,Borrmann Ⅰ型、Ⅱ型和Ⅲ型胃癌内镜活检多能明确诊断,第1次活检确诊率达88.5%以上。再次内镜活检取材,97.4%以上的病例能确诊。36例内镜可疑为 BorrmannⅥ型胃癌首次活检14例(38.9%)为粘膜炎症反应,未见癌瘤细胞。虽经再次活检,仍有12例(33.3%)未能获得明确诊断.该型胃癌在 EUS 下声像图常有特征性的变化,表现为大部分或全胃壁弥漫性全层增厚,粘膜下层尤明显,回声减弱。增厚的胃壁并无明显结构紊乱,其层次尚可辨认。根据这一特征,36例内镜疑诊为该型的胃癌病变均行 EUS 检查,均作出了正确的诊断,确诊率达100%。结论:EUS 能显示 BorrmannⅣ型胃癌特征性的变化,用于该型胃癌的诊断,优于内镜及活检检查。

类似早期型与类似Borrmann型pm胃癌病理及预后的研究

本文对30例类似早期型与78例类似Borrmann型中期胃癌(pm胃癌)进行比较,其5年生存率分别为86.7%和57.9%(P<0.05)。类似早期型pm癌浸润深度多在肌层浅、中部,浆膜多呈轻反应型改变。类似Borrmann型浸润多在肌层深部,浆膜呈重反应型改变。术前行胃镜或X线双重造影,结合术中对胃浆膜的观察,有助于pm癌的诊断。

转化生长因子β1、I型胶原在Borrmann Ⅳ型胃癌形成中的作用研究

[目的]分析转化生长因子β1(TGF-β1)表达与胃癌肉眼形态的关系及其在Ⅰ型胶原(Colla-genⅠ)合成中的作用,初步探讨TGF-β1与Ⅳ型胃癌形成的关联。[方法]通过免疫组织化学染色SP方法,分析了109例胃癌患者原发灶中TGF-β1及CollagenⅠ的表达。[结果]TGF-β1表达分级在Borrmann分型各型间有显著性差异(P<0.005),BorrmannⅣ型胃癌TGF-β1呈++^+++级表达的占96%,而在Ⅰ、Ⅱ、Ⅲ型中分别为38.46%、76.31%、81.82%;TGF-β1表达与CollagenⅠ表达有相关关系(P<0.005);CollagenⅠ表达在Borrmann分型各型间有显著性差异(P<0.001),Borrmann分型为Ⅰ、Ⅱ、Ⅲ、Ⅳ型的CollagenⅠ表达面积比分别为8.22±0.81、8.69±0.90、11.20±1.45、14.27±1.71。Ⅳ型与Ⅰ、Ⅱ、Ⅲ型之间均有显著性差异(P<0.001)。[结论]TGF-β1表达与CollagenⅠ表达有明显相关性,在以胃壁广泛纤维化为特点的BorrmannⅣ型胃癌形成过程中起促进作用。

多西紫杉醇及氟尿嘧啶辅助化疗治疗BorrmannIV型胃癌的临床研究

目的观察多西紫杉醇联合顺铂及氟尿嘧啶/亚叶酸钙（5-Fu/CF）方案新辅助化疗治疗BorrmannⅣ型胃癌的疗效。方法自2002年7月至2004年7月，将55例BorrmannⅣ型胃癌分为两组，新辅助化疗组29例（NCT组），术前给予多西紫杉醇75mg/m^2，第1天，静脉点滴；顺铂30mg/m^2，第1-3天，静脉点滴；5-Fu500mg/m^2，第1-5天，静脉点滴；亚叶酸钙200mg/m^2于5-Fu前30min冲入，每3周为1个周期，共3个周期。术后又给予3个周期化疗。对照组26例（非NCT组），在术后给予6个周期的化疗。观察新辅助化疗后肿瘤原发病灶的缓解情况、手术根治切除率、术后病理缓解率、切缘癌残留以及淋巴结转移情况及毒性反应等。结果29例BorrmannⅣ型胃癌患者经新辅助化疗后，临床有效率RR（CR＋PR）为58.6%，病理缓解率为6.8%，临床表现为原发肿瘤缩小，淋巴转移减少，降低了临床分期，同对照组比，提高了手术根治切除率，并降低术后切缘癌残留率，延长了患者生存期。毒性反应轻，无严重感染和死亡病例。结论采用多西紫杉醇联合顺铂及氟尿嘧啶/亚叶酸钙（5-Fu/CF）的方案进行BorrmannⅣ型胃癌的新辅助化疗，疗效显著，患者耐受性良好。

Borrmann Ⅳ型胃癌的多排螺旋CT特征及对临床病理的影响

目的探讨Borrmann Ⅳ型胃癌的多排螺旋CT(multi-detector spiral computed tomography,MDCT)特征及对临床病理的影响。方法回顾性分析136例经手术病理证实的Borrmann Ⅳ型胃癌患者的MDCT,采用水作为阴性对比剂,分别获取24 s(动脉期)、60 s(静脉期)和120 s(平衡期)的CT图像。由两名放射科医生观察图像并分析病灶分层强化的特征,将强化程度分为4种类型(不强化、轻度强化、中度强化和明显强化),影像参数还包括病灶部位、长度及最大厚度、浸润深度及淋巴结转移等。结果 136例病例中有96例在增强动脉期呈现分层强化的模式(内层中度强化、外层轻度强化),123例在增强静脉期呈现分层强化的模式(内层中度-明显强化、外层轻度-中度强化)。从动脉期至平衡期,增厚的胃壁呈由内向外透壁性强化,并在静脉期达强化峰值。在增强各期CT值得测量中,内层(99.6±19.8)HU的平均CT值高于外层(63.1±15.2)HU,差异有统计学意义(P <0.01)。病理分析结果中,135/136例为腺癌(1例为未分化癌),肿瘤基质均为sci,浸润模式均为INFc。结论 Borrmann Ⅳ型胃癌在MDCT扫描中具有一定特点,倾向于呈现分层强化的模式;自动脉期至平衡期,增厚的胃壁呈由内向外透壁性强化,并在静脉期达强化峰值。

腹腔热灌注化疗对不同病理类型和Borrmann分型进展期胃癌患者的预后分析

目的:回顾性分析行手术联合术后腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)与同期单纯手术胃癌患者的临床病理资料,以期了解HIPEC对局部进展期胃癌患者预后的影响。方法:回顾性分析2009年1月~2014年1月在天津医科大学肿瘤医院行HIPEC的80例Ⅲb期胃癌患者与同期单纯手术90例Ⅲb期胃癌患者。根据术后是否使用腹腔热灌注化疗分为HIPEC组(研究组)和单纯手术组(对照组)。研究组:印戒细胞癌24例,非印戒细胞癌56例;BorrmannⅠ型12例,BorrmannⅡ型28例,BorrmannⅢ型23例,BorrmannⅣ型17例。对照组:印戒细胞癌26例,非印戒细胞癌64例;BorrmannⅠ型15例,BorrmannⅡ型30例,BorrmannⅢ型26例子,BorrmannⅣ型19例。两组患者术后4周均予以SOX方案化疗8个疗程。分析比较不同病理类型及Borrmann分型的胃癌患者术后生存情况,并对两组患者手术相关并发症进行对比。结果:研究组和对照组患者5年生存率分别为36.25%和28.89%(P<0.05);印戒细胞癌患者中,研究组和对照组患者5年生存率分别为25.00%和15.38%(P<0.05);非印戒细胞癌患者中,研究组和对照组患者5年生存率分别为41.07%和34.38%(P>0.05);BorrmannⅠ型胃癌患者中,研究组和对照组患者5年生存率分别为41.67%和40.00%(P>0.05);BorrmannⅡ型胃癌患者中,研究组和对照组患者5年生存率分别为35.71%和33.33%(P>0.05);BorrmannⅢ型胃癌患者中,研究组和对照组患者5年生存率分别为39.13%和26.92%(P<0.05);BorrmannⅣ型胃癌患者中,研究组和对照组患者5年生存率分别为29.41%和15.79%(P<0.05)。两组患者手术相关并发症的差异无统计学意义(P>0.05)。结论:手术联合HIPEC安全可行,有利于提高患有印戒细胞癌、BorrmannⅢ型及BorrmannⅣ型进展期胃癌患者术后的5年生存率,延长生存期。

早期胃癌样5型进展期胃癌的形态及生物学特点

目的分析早期胃癌样5型进展期胃癌(5型胃癌)的临床及生物学特征。方法对手术确诊的398例胃癌中符合5型胃癌的17例患者,分析其内镜与大体标本形态学、组织病理学结果。结果17例5型胃癌占同期胃癌总数的4.3%,占进展期胃癌的5.3%,所有患者均行根治手术。形态学分类显示本组中Ⅱc型比例最高(8/17,47.0%),其次为Ⅱa+Ⅱc型(7/17,41.2%)及Ⅱc+Ⅲ型(2/17,11.8%),Ⅱa+Ⅱc型在5型进展期胃癌中所占比例较早期胃癌中高(P<0.05)。该组中分化型癌8例,未分化型9例,与同期早期胃癌相比分化程度未见明显差异,女性患者分化程度较男性患者差(P<0.01)。5例患者(29.4%)伴淋巴结及周围脏器转移,转移发生率较同期早期胃癌为高。结论5型胃癌形态学及病理学特征均不同于传统意义的进展期癌与早期胃癌,内镜检查中仔细评估病灶蠕动及伸展性、超声内镜、钡餐及螺旋CT检查可能有助于鉴别5型进展期胃癌与早期胃癌,提高术前诊断准确性。

胃癌结直肠转移瘤的MSCT诊断

目的分析胃癌结直肠转移瘤的MSCT表现。方法分析52例胃癌结直肠转移患者的临床与CT资料。结果1)胃癌病理类型为低分化腺癌或印戒细胞癌及两者混合者45例;Ⅲ型及Ⅳ型48例;2)转移瘤表现为均匀增厚型39处,非均匀增厚型21处,管腔内生肿块型6处,管腔外突肿块型4处;3)转移瘤表现为均匀性强化16处;不均匀性强化10处;分层样强化44处;4)12例(52.2%)女性患者伴卵巢转移。结论发生结直肠转移的胃癌病理类型主要为低分化腺癌及印戒细胞癌,Borrmann分型以Ⅲ、Ⅳ型为主。结直肠转移瘤最具特征性的CT征象为肠壁呈靶样同心圆样改变。女性患者常伴卵巢转移。

淋巴结转移特征在胃癌外科治疗中的意义

目的：探讨胃癌患者淋巴结转移特征及其在外科治疗中的临床意义。方法回顾性分析行手术治疗的460例胃癌患者的临床资料，就其淋巴结转移特征，按照肿瘤TNM分期、原发灶大小以及Borrmann大体分型分别对患者进行分组，比较组间淋巴结转移发生率的差异。结果460例患者中，320例检出淋巴结转移，淋巴结转移发生率69．57％（320／460）。淋巴结转移发生率与胃癌的TNM分期、原发灶大小以及Borrmann大体分型相关，TNM分期越晚、原发灶直径越大、Borrmann大体分型级别越高，则患者淋巴结转移发生率越高，组间差异有统计学意义（P＜0．05）。结论淋巴结转移发生率与胃癌患者的肿瘤TNM分期、原发灶大小以及Borrmann大体分型相关。

胃癌采用320排容积CT进行术前分型及TNM分期价值

目的分析胃癌术前Borrmann分型和TNM分期采用320排容积CT的临床价值。方法选取我院2019年3月~2020年3月收治的72例胃癌患者,所有患者均接受320排容积CT扫描和超声内镜检查,72例患者均接受外科手术治疗,以术后病理为标准,计算320排容积CT和超声内镜对胃癌Borrmann分型和TNM分期的准确率,并将统计数据进行组间比较。结果320排容积CT检查和超声内镜对Borrmann分型(84.45%vs 90.91%)、T分期(86.67%vs 90.00%)的诊断准确率差异无统计学意义(χ^(2)=1.138、0.069,P=0.286、0.703);320排容积CT检查胃癌N分期(93.06%vs 80.56%)、M分期(94.44%vs 83.33%)诊断准确率高于超声内镜(χ^(2)=4.911、4.500,P=0.027、0.034),差异均有统计学意义。结论320排容积CT在胃癌术前Borrmann分型和TNM分期中具有较高的准确率,有利于选择合适的手术治疗方式,提高患者治疗效果。

弥漫浸润型胃癌患者术前多西紫杉醇+顺铂+氟尿嘧啶方案化疗的疗效及安全性观察

目的探讨多西紫杉醇+顺铂+氟尿嘧啶(DCF)方案应用于弥漫浸润型(BorrmannⅣ)胃癌患者术前化疗的疗效与安全性。方法 44例进展期Borrmann IV型胃癌患者,术前分为化疗+手术组和常规手术组,化疗+手术组患者术前行DCF方案化疗2周期。观察化疗+手术组的化疗毒副反应、CT缓解程度、病理反应程度。评价CT缓解程度与病理反应程度之间的关系。比较两组间R0切除率及生存期的差异。结果化疗+手术组化疗后的毒副反应以恶心、呕吐为主,未出现IV级不良反应。CT缓解程度中总有效率为68.1%,肿瘤控制率为90.9%,降期率27.3%。病理反应分级中有效4例,占18.18%(4/22)。CT缓解程度与病理反应程度无相关性(rs=-0.42,P=0.051)。化疗+手术组的R0切除率明显高于常规手术组,差异有统计学意义(P<0.05)。两组生存期比较差异无统计学意义(P>0.05)。结论 DCF方案应用于Borrmann IV型胃癌术前化疗是安全的,可提高Borrmann IV型胃癌的R0切除率。