Outcome of gastric cancer patients after successful gastrectomy - Influence of the type of recurrence and histology on survival
Outcome of gastric cancer patients after successful gastrectomy - Influence of the type of recurrence and histology on survival
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DOI：
10.1002/cncr.22317
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发表时间：
2006-12-01
期刊：
影响因子：
6.2
通讯作者：
Ajani, Jaffer A.
中科院分区：
文献类型：
--
作者：
Rohatgi, Pooja R.;Yao, James C.;Ajani, Jaffer A.
背景根治性（R 0）胃切除术后疾病复发的部位对患者生存率的影响尚未阐明。作者假设复发的位置对生存率有显著影响。所有在德克萨斯大学M。D.本文回顾了安德森癌症中心1985年至1998年的资料。分析了因胃癌接受R 0切除术并随后发生局部（吻合口）复发（LR）、淋巴结（区域）复发（NR）或远处转移（DM）的患者的总生存期（OS）。将所有研究因素输入考克斯比例风险模型，以提供多变量风险比。该模型调整了原发部位复发，组织学分级，患者年龄和原发肿瘤的位置的影响。该回顾性分析包括227例连续患者。发生NR的患者的中位生存期（11个月）与发生LR的患者（10个月）相似，但两组的中位生存期均显著长于发生DM的患者（7个月;对数秩P = .03）。高分化或中分化肿瘤患者的OS（11个月）长于低分化肿瘤患者（8个月;对数秩P = 0.02）。在这个队列中，原发癌的位置和复发时的年龄对OS没有显著影响。本研究的数据表明，在因胃癌接受R 0胃切除术的患者中，LR和NR与DM应被视为基于生存率显著差异的随机试验的有效分层因素。确定这种分层是否适用于组织学分化需要在更大的多中心队列中进行进一步研究。
BACKGROUND. The effect of the location of disease recurrence after curative (R0) gastrectomy on patient survival has not been elucidated. The authors hypothesized that the location of recurrence would have a significant influence on survival.METHODS. Medical records of all patients who received treatment for gastric cancer at The University of Texas M. D. Anderson Cancer Center between 1985 and 1998 were reviewed. Patients who underwent R0 resection for gastric cancer and subsequently developed localized (anastomotic) recurrence (LR), lymph node (regional) recurrence (NR), or distant metastases (DM) were analyzed for overall survival (OS). All study factors were entered into a Cox proportional hazards model to provide multivariate hazard ratios. The model was adjusted for the effects of primary site of recurrence, histologic grade, patient age, and location of the primary tumor.RESULTS. This retrospective analysis included 227 consecutive patients. The median survival of patients who developed NR (11 months) was similar to that of patients who developed LR (10 months), but both groups had significantly longer median survival compared with patients who developed DM (7 months; log-rank P = .03). Patients who had well differentiated or moderately differentiated tumors had a longer OS (11 months) than patients who had poorly differentiated tumors (8 months; log-rank P = .02). In this cohort, location of the primary cancer and age at recurrence had no significant impact on OS.CONCLUSIONS. The data from this study suggested that, among patients who undergo R0 gastrectomy for gastric cancer, LR and NR versus DM should be considered a valid stratification factor for randomized trials based on significant differences in survival. Determining whether this stratification should apply to histologic differentiation will require further investigation in a larger multicenter cohort.