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目的总结和分析残胃癌的治疗方式及预后因素。方法收集2000年3月至2008年5月期间,川北医学院附属第二医院和中国人民解放军总医院收治的共114例残胃癌患者的临床病理学资料,分析其治疗方式及影响预后的因素。结果全组病例手术切除率和R0切除率分别为57.0%(65/114)及54.4%(62/114),行全胃切除、远端胃部分切除、近端胃部分切除、内镜下黏膜切除术(EMR)及内镜下黏膜剥离术(ESD)者分别占手术切除者的73.8%(48/65)、16.9%(11/65)、3.1%(2/65)、4.6%(3/65)及1.5%(1/65),分别占R0切除者的75.8%(47/62)、16.1%(10/62)、3.2%(2/62)、4.8%(3/62)及0。75例获随访,随访时间为0.3～79.0个月,中位随访时间为12个月;总体中位生存时间为19.5个月,1、3及5年累积生存率分别为61.8%、42.3%和30.1%。多因素分析结果显示,首次行远端胃切除(P=0.002)、KPS评分≥80分(P=0.016),大体分型低(P=0.013)和临床无远处转移(P=0.000)者,手术切除率均较高;R0切除(P=0.000)、大体分型(P=0.005)和临床T分期(P=0.006)为残胃癌的独立预后因素。无论是单因素还是多因素分析,原发疾病的良恶性质均不影响预后(P>0.05)。姑息性手术切除、姑息化疗、单纯剖腹手术及最佳支持治疗间的总体生存曲线比较差异无统计学意义(P>0.05)。结论原发疾病的性质不影响残胃癌的治疗及预后,R0切除是残胃癌最重要的独立预后因素;残胃癌的最佳手术方式是切除全部残胃,应尽量避免姑息性剖腹手术。
Objective To summarize and analyze the treatment methods and prognostic factors of gastric stump cancer. Methods A total of 114 patients with gastric cancer who were admitted to the Second Affiliated Hospital of North Sichuan Medical College and PLA General Hospital from March 2000 to May 2008 were collected. The clinicopathological data were collected. The treatment methods and prognostic factors were analyzed. Results The total resection rate and R0 resection rate were 57.0% (65/114) and 54.4% (62/114) respectively. Total gastrectomy, distal partial gastrectomy, proximal partial gastrectomy, endoscopic mucosa Resectomy (EMR) and endoscopic mucosal dissection (ESD) accounted for 73.8% (48/65), 16.9% (11/65), 3.1% (2/65), 4.6% / 65) and 1.5% (1/65), accounting for 75.8% (47/62), 16.1% (10/62), 3.2% (2/62), 4.8% 0.75 were followed up for 0.3 to 79.0 months, with a median follow-up time of 12 months. The overall median survival time was 19.5 months. The cumulative 1,3 and 5-year cumulative survival rates were 61.8% and 42.3, respectively % And 30.1%. Multivariate analysis showed that for the first time, distal gastrectomy (P = 0.002), KPS score≥80 (P = 0.016), general classification low (P = 0.013) and clinical no distant metastasis (P = 0.000), general classification (P = 0.005) and clinical T stage (P = 0.006) were independent prognostic factors for gastric residual cancer. No matter the single factor or the multivariate analysis, the benign and malignant nature of the primary disease did not affect the prognosis (P> 0.05). There was no significant difference in the overall survival curve between palliative resection, palliative chemotherapy, simple laparotomy and best supportive care (P> 0.05). Conclusions The nature of the primary disease does not affect the treatment and prognosis of residual gastric cancer. R0 resection is the most important independent prognostic factor for residual gastric cancer. The best surgical method for residual gastric cancer is removal of all residual stomach. Palliative surgery should be avoided as far as possible.