Ethnic survival differences after gastrectomy for gastric cancer are better explained by factors specific for disease location and individual patient comorbidity
Ethnic survival differences after gastrectomy for gastric cancer are better explained by factors specific for disease location and individual patient comorbidity
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DOI：
10.1053/ejso.2001.1234
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发表时间：
2002-04-01
期刊：
影响因子：
--
通讯作者：
Zagala-Nevarez, K
中科院分区：
文献类型：
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作者：
Schwarz, RE;Zagala-Nevarez, K
引言：不同种族患者组之间胃癌切除术后的不同结局已被描述。目前还不清楚是否差异的治疗形式，疾病相关的变量，或个别患者占这种effect.Methods：在1989年和1999年之间的10年间，75例胃腺癌患者进行胃切除术在一个单一的机构，在此期间，包括完整的（RO）切除尝试和扩大淋巴结切除术的手术标准。种族，疾病特征，和治疗变量进行了分析，他们对survival.Results的影响：有40名男性和35名女性，中位年龄为67岁（范围31-97）。胃切除范围为全胃切除术（n = 25）、近端胃切除术（n = 18）、次全胃切除术（n = 17）、远端胃切除术（n = 14）和节段性胃切除术（n = 1）。平均淋巴结计数为25 +/- 17（SD）。有1例术后死亡，总体并发症发生率为27%;中位住院时间为11天。总体精算5年生存率为33%（95% CI：19-47）;潜在可治愈疾病（IA-IIIB期）导致中位生存期为49个月。亚裔（n=18）和西班牙裔患者（n=20）的生存率显著高于白人（n=31）或其他患者（n=6）（P=0.01）。种族与原发肿瘤的位置（P=0.002）、胃切除范围（P=0.003）、患者既往腹部手术（P=0.01）或吸烟史（P=0.03）有关，但与切除范围参数（如取出的淋巴结数量）或病理特征差异无关。当控制疾病部位、分期、R状态和患者合并症的差异时，种族并没有保留对生存的独立预后影响。结论：在本研究中，胃腺癌患者行胃切除术后生存率的明显差异有利于亚洲和西班牙裔患者，这可以用不同的疾病模式来解释（远端位置），相关的需要更少的广泛的程序（如全胃切除术），并减少患者的风险（烟草，先前的手术，非癌症死亡）。我们的治疗方法仍然是积极的胃切除术/淋巴结切除术的组合，潜在的可治愈的胃癌，不考虑种族患者的因素。(C)，2002 Elsevier Science Ltd.
Introduction: Different outcomes after resection of gastric cancer between various ethnic patient groups have been described. It remains unclear whether disparity of treatment forms, disease-related variables, or individual patients accounts for this effect.Methods: In the 10 years between 1989 and 1999, 75 patients with gastric adenocarcinoma underwent gastrectomy at a single institution, with constant surgical standards during this time period, including complete (RO) resection attempt and extended lymphadenectomy. Ethnicity, disease characteristics, and treatment variables were analysed for their impact on survival.Results: There were 40 males and 35 females, with a median age of 67 years (range 31-97). The gastrectomy extent was total (n = 25), proximal (n = 18), subtotal (n = 17), distal (n = 14), and segmental (n = 1). The mean lymph-node count was 25 +/- 17 (SD). There was one post-operative death, and an overall complication rate of 27%; the median hospital stay was I I days. Overall actuarial 5-year survival was 33% (95% Cl: 19-47); potentially curable disease (stage IA-IIIB) led to a median survival of 49 months. Asian (n=18) and Hispanic patients (n=20) had significantly better survival than Caucasian (n=31) or other patients (n=6) (P=0.01). Ethnicity was linked to the location of the primary tumour (P=0.002), the gastrectomy extent (P=0.003), and the patient's prior abdominal operation (P=0.01) or tobacco history (P=0.03), but not to resection extent parameters (such as number of lymph nodes retrieved) or differences in pathologic characteristics. When controlling for differences of disease site, stage, R status, and patient comorbidity, ethnicity did not retain an independent prognostic impact on survival.Conclusions: Obvious survival differences after gastrectomy for gastric adenocarcinoma favouring Asian and Hispanic patients in this experience can be explained by different disease patterns (distal location), the related need for fewer extensive procedures (such as total gastrectomy), and diminished patient risks (tobacco, prior operations, noncancer deaths). Our therapeutic approach remains an aggressive gastrectomy/lymphadenectomy combination for potentially curable gastric cancer, irrespective of ethnic patient factors. (C), 2002 Elsevier Science Ltd.