Recurrence following curative resection for gastric carcinoma
Recurrence following curative resection for gastric carcinoma
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DOI：
10.1046/j.1365-2168.2000.01360.x
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发表时间：
2000-02-01
影响因子：
9.6
通讯作者：
Min, JS
中科院分区：
文献类型：
--
作者：
Yoo, CH;Noh, SH;Min, JS
背景：复发性胃癌的诊断和治疗一直是个难题。本研究旨在探讨胃癌复发的危险因素及预后。方法：对1987~1995年收治的2328例胃癌根治术患者中经临床检查或再次手术证实复发的508例患者进行回顾性研究。结果：平均复发时间为21.8个月，腹膜复发发生率最高(45.9%)。Logistic回归分析显示浆膜侵犯和淋巴结转移是所有复发类型和早期复发(24个月或以下)的危险因素。此外，每种复发模式涉及的独立危险因素包括：低龄、浸润型或弥漫型、未分化肿瘤和全胃切除导致腹膜复发；高龄和肿瘤体积较大的播散性、血源性复发；高龄、较大的肿瘤体积、浸润型或弥漫型、近端肿瘤和胃大部切除术导致局部区域复发。早期复发的危险因素还有浸润型或弥漫型和全胃切除。再手术治愈仅19例，保守治疗或姑息性手术后平均生存期<12个月。结论：根据原发肿瘤的临床病理特征，可预测各种复发方式和复发时间的危险因素。由于治疗结果仍然令人沮丧，研究围手术期辅助治疗以试图减少复发是有必要的。
Background: The diagnosis and treatment of recurrent gastric cancer remains difficult. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the prognosis for these patients.Methods: Of 2328 patients who underwent curative resection for gastric cancer from 1987 to 1995, 508 whose recurrence was confirmed by clinical examination or reoperation were studied retrospectively. The risk factors that determined the recurrence patterns and timing were investigated by univariate and multivariate analysis.Results: The mean time to recurrence was 21.8 months and peritoneal recurrence was the most frequent (45.9 per cent). Logistic regression analysis showed that serosal invasion and lymph node metastasis were risk factors for all recurrence patterns and early recurrence (at 24 months or less). In addition, independent risk factors involved in each recurrence pattern included younger age, infiltrative or diffuse type, undifferentiated tumour and total gastrectomy for peritoneal recurrence; older age and larger tumour size for disseminated, haematogenous recurrence; and older age, larger tumour size, infiltrative or diffuse type, proximally located tumour and subtotal gastrectomy for locoregional recurrence. Other risk factors for early recurrence were infiltrative or diffuse type and total gastrec-tomy. Reoperation for cure was possible in only 19 patients and the mean survival time after conservative treatment or palliative operation was less than 12 months.Conclusion: The risk factors for each recurrence pattern and timing of gastric cancer can be predicted by the clinicopathological features of the primary tumour. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.