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Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach 被引量:16
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作者 Hong-Mei Wang, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Department of Gastric Surgery, Affiliated Union Hospital of Fujian Medical University, Fuzhou 350001, Fujian Province, China Author contributions: Wang HM and Huang CM conceived of the study, analyzed the data, and drafted the manuscript Zheng CH, Li P and Xie JW helped revise the manuscript critically for important intellectual content +1 位作者 Wang JB, Lin JX and Lu J helped collect data and design the study and all authors read and approved the final manuscript. 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第38期5470-5475,共6页
AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced ... AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach. 展开更多
关键词 gastric carcinoma Prognosis Receiver operating characteristic curve The lower third of stomach Tumor size
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胃上部癌与胃下部癌临床病理特点及预后的对比分析 被引量:15
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作者 刘峥嵘 张静 +3 位作者 鲁翀 李国胜 王红岩 徐惠绵 《中国普通外科杂志》 CAS CSCD 2008年第4期299-302,共4页
目的对比分析胃上部癌与胃下部癌临床病理特点及预后。方法回顾性分析1999年1月—2003年12月手术切除的胃上部癌(U组)73例,胃下部癌(L组)366例的临床病理资料。结果U组男性多于女性(P<0.01);肿块直径大于5cm者U组明显多于L组(P<0.... 目的对比分析胃上部癌与胃下部癌临床病理特点及预后。方法回顾性分析1999年1月—2003年12月手术切除的胃上部癌(U组)73例,胃下部癌(L组)366例的临床病理资料。结果U组男性多于女性(P<0.01);肿块直径大于5cm者U组明显多于L组(P<0.05);团块性生长L组明显多于U组(P<0.05),而弥漫性生长者U组明显多于L组(P<0.05);U组中早期胃癌病例数明显少于L组(P<0.01);U组中T1期明显少于L组(P<0.01),而T3和T4期明显多于L组(P<0.05);U组中N2+N3淋巴结转移阳性病例明显多于L组(P<0.05);U组以低、未分化型癌为主,且明显多于L组(P<0.05);U组的手术根治度多以B级和C级为主,A级明显少于L组(P<0.05);U组中位生存期为42个月,L组中位生存期为60个月;U组5年生存率明显低于L组(P<0.01),两组生存曲线比较有显著差异(P<0.01)。结论与胃下部癌比较,胃上部癌男性多于女性,肿块大、病期晚,以弥漫型生长,分级程度低为主要病理生物学特点;手术方式以相对根治和姑息切除为多,绝对根治者少,生存率低。因此,对胃上部癌治疗应采取以手术为主的综合治疗。 展开更多
关键词 胃肿瘤/外科学 胃上部癌 胃下部癌 对比研究
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不同部位胃癌组织临床病理特点和生物学行为的差异 被引量:11
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作者 周思宁 周小兰 《世界华人消化杂志》 CAS 北大核心 2014年第18期2607-2611,共5页
目的:探讨胃上部癌与胃下部癌临床病理特点和生物学行为差异.方法:回顾性分析我院收治的107例胃上部癌和505例胃下部癌患者临床病理相关因素,并对癌淋巴转移与病理因素的关系进行分析.结果:胃上部癌与下部癌患者在性别(86.92%v s 69.31%... 目的:探讨胃上部癌与胃下部癌临床病理特点和生物学行为差异.方法:回顾性分析我院收治的107例胃上部癌和505例胃下部癌患者临床病理相关因素,并对癌淋巴转移与病理因素的关系进行分析.结果:胃上部癌与下部癌患者在性别(86.92%v s 69.31%)、(13.08%v s 31.09%),年龄(3.74%vs 10.50%)、(14.02%vs 20.00%)、(36.45%vs 29.31%),病灶大小(43.93%vs51.88%)、(5.61%vs 2.18%),大体类型(2.80%vs 8.71%)、(29.91%vs 35.84%)、(67.29%vs 55.45%),组织分型(48.60%vs 56.44%)、(51.40%vs 43.56%),生长方式(20.56%vs35.05%)、(46.73%v s 32.28%),病理分期(6.54%vs 23.37%)、(12.15%vs 32.48%)、(51.40%vs 27.13%)、(29.91%vs 17.03%),浸润深度(2.80%vs 8.71%)、(32.71%vs29.11%)、(13.08%vs 6.34%)分布以及器官受侵(27.10%vs 28.51%),浆膜受侵(63.55%vs 34.65%),断端残留(9.35%vs 0.99%)发生率上存在显著差异,差异具有统计学意义(P<0.05);胃上部癌、胃下部癌患者肿瘤大体类型(33.33%vs 40.63%vs 59.72%)、(9.09%vs 44.20%vs 62.86%)、生长方式(13.64%vs 57.14%vs 68.00%)、(24.86%vs35.15%vs 74.85%)、浸润深度(33.33%vs38.18%vs 60.00%vs 100.00%)、(9.09%vs43.62%vs 70.07%vs 96.88%)以及是否发生浆膜入侵(30.77%vs 66.18%)、(40.91%vs72.00%)均为影响淋巴结转移的主要因素,差异具有统计学意义(P<0.05);胃上部癌、胃下部癌患者肿瘤病灶大小(40.43%vs 61.11%vs 83.33%)、(42.75%vs 60.78%vs 72.73%),组织分型(53.85%vs 52.73%)、(54.39%vs48.18%)均与淋巴结转移无关,差异无统计学意义(P>0.05);胃上部癌患者淋巴结总转移率与胃下部癌患者比较(53.27%vs 51.68%),差异无统计学意义(P>0.05),表明肿瘤发生部位与淋巴结转移率无关.结论:胃上部癌与胃下部癌临床病理生物学行为和淋巴结转移规律存在多方面差异,与胃下部癌相比,胃上部癌具有病灶较大、呈浸润型弥漫生长、分化程度低、浆膜易受侵、病期偏晚等特点,而淋巴转移方面并不突出,这可能是导致胃上部癌预后较差的重要原因. 展开更多
关键词 胃上部癌 胃下部癌 病理特点 淋巴结转移
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老年晚期食管下段癌、贲门癌治疗方法探讨 被引量:3
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作者 温海华 韩冰 《中国现代医生》 2012年第7期37-39,41,共4页
目的探索老年晚期食管下段癌、贲门癌的治疗方法。方法经胃左动脉介入,灌药(ADM、DDP、5-FU)加栓塞(碘化油、明胶海绵颗粒)治疗老年晚期食管下段癌、贲门癌患者50例,分别从近期吞咽梗阻症状的变化、4周后生活质量、生存期(或生存率)及... 目的探索老年晚期食管下段癌、贲门癌的治疗方法。方法经胃左动脉介入,灌药(ADM、DDP、5-FU)加栓塞(碘化油、明胶海绵颗粒)治疗老年晚期食管下段癌、贲门癌患者50例,分别从近期吞咽梗阻症状的变化、4周后生活质量、生存期(或生存率)及其并发症四方面讨论胃左动脉介入治疗老年晚期食管下段癌、贲门癌的临床意义。结果介入后24~72 h所有吞咽困难患者,症状均有不同程度缓解,有效率100%。介入4周后,CR 21例,PR 17例,RR 76%;CBR 90%,10%无效。介入前后比较PS评分:<2分者0:10;OSF(OSR)>12个月19例,占43.2%;其中20~24个月5例,占约11.4%,1例生存32个月;无一例介入相关严重并发症发生。结论胃左动脉介入法是治疗老年晚期食管下段癌、贲门癌的较好方法,可以在介入技术成熟的医院作为老年晚期食管下段癌、贲门癌的首选疗法。 展开更多
关键词 老年 晚期食管下段癌 贲门癌 胃左动脉介入 灌药加栓塞
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胃下部癌No.6组淋巴结分拣特点和转移危险因素分析
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作者 李疆 曹英豪 +1 位作者 邓胜和 蔡开琳 《临床外科杂志》 2022年第9期830-834,共5页
目的 探讨胃下部癌No.6组淋巴结分拣特点和转移危险因素,为规范腹腔镜下远端胃癌根治术淋巴结按组分拣提供支持。方法 2017年1月~2017年12月在我院胃肠外科行腹腔镜下远端胃癌D2根治术的胃下部癌病人66例。按照胃癌D2清扫范围对标本行... 目的 探讨胃下部癌No.6组淋巴结分拣特点和转移危险因素,为规范腹腔镜下远端胃癌根治术淋巴结按组分拣提供支持。方法 2017年1月~2017年12月在我院胃肠外科行腹腔镜下远端胃癌D2根治术的胃下部癌病人66例。按照胃癌D2清扫范围对标本行淋巴结分拣并计算No.1、No.3、No.4sb、No.4d、No.5、No.6、No.7、No.8a、No.9、No.11p和No.12a各组分拣淋巴结总数、转移淋巴结总数、淋巴结转移的病人所占的比例和各组淋巴结转移比率。记录病人的性别、年龄、浸润深度、肿瘤直径、分化程度、神经侵犯、脉管侵犯、体质指数、HER2表达、肿瘤周围癌结节和肿瘤位置。总结No.6组淋巴结的分拣特点;单因素和多因素分析No.6组淋巴结转移的危险因素。结果 No.6组淋巴结转移的病人比例为18/66(27.3%),淋巴结转移率为60/233(25.8%);单因素分析显示,病灶浸润深度(χ~2=7.153,P=0.007)、神经侵犯(χ~2=8.503,P=0.004)、脉管侵犯(χ~2=5.677,P=0.017)、HER2表达(χ~2=4.979,P=0.026)和肿瘤周围癌结节(χ~2=5.408,P=0.020)均与No.6组淋巴结转移相关(P<0.05);No.6组淋巴结转移与No.3组(χ~2=5.432,P=0.020)、No.7组(χ~2=12.726,P=0.000)、No.8a组(χ~2=10.615,P=0.001)和No.9组淋巴结转移(χ~2=7.787,P=0.005)密切相关(P<0.05);Logistic回归进行多因素分析显示,肿瘤周围癌结节(OR=15.648,95%CI:2.946~83.118)和HER2表达(OR=11.706,95%CI:2.018~67.890)是No.6组淋巴结转移的独立危险因素(P<0.05)。结论 腹腔镜下远端胃癌根治术应重视No.6组淋巴结转移和清扫,根据No.6组淋巴结的转移情况适当扩大淋巴结的清扫范围。 展开更多
关键词 胃下部癌 淋巴结转移 第6组淋巴结 淋巴结分拣
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胃底成形及幽门扩张术治疗食管下段癌贲门癌(附165例报告) 被引量:1
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作者 黄犇 周克春 +1 位作者 张玉展 似继承 《中国医药导刊》 2011年第9期1515-1516,共2页
目的:为了预防食管胃吻合口的并发症。方法:作者设计了食管胃部分切除后胃底成形再造术重建消化道,同期经胃切口行幽门扩张治疗食管下段癌、贲门癌。结果:采用该术式治疗食管下段鳞状细胞癌43例,贲门腺癌125例,无手术死亡。手术后近期... 目的:为了预防食管胃吻合口的并发症。方法:作者设计了食管胃部分切除后胃底成形再造术重建消化道,同期经胃切口行幽门扩张治疗食管下段癌、贲门癌。结果:采用该术式治疗食管下段鳞状细胞癌43例,贲门腺癌125例,无手术死亡。手术后近期吻合口瘘、吻合口狭窄和返流性食管炎等吻合并发症的发生率明显降低。结论:本方法操作简单,有效地预防了食管胃吻合口并发症的发生,有实用价值。 展开更多
关键词 食管下段癌 贲门癌 胃底成形 幽门扩张
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