Risk factors of peritoneal recurrence in eso-gastric signet ring cell adenocarcinoma: Results of a multicentre retrospective study
Risk factors of peritoneal recurrence in eso-gastric signet ring cell adenocarcinoma: Results of a multicentre retrospective study
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DOI：
10.1016/j.ejso.2012.12.013
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发表时间：
2013-03-01
期刊：
影响因子：
3.8
通讯作者：
Mariette, C.
中科院分区：
文献类型：
--
作者：
Honore, C.;Goere, D.;Mariette, C.
简介：印戒细胞（SRC）食管胃腺癌（EGA）预后差可能与其对腹膜的高度亲和性有关。本研究的目的是确定腹膜癌复发（PCR）的预测因素，根治性手术后，从而确定高风险patients.Methods：回顾性全国调查进行了19个法国外科中心之间的1997年和2010年。纳入了从根治性手术中获益且无术后死亡的非转移性疾病患者。没有达到24个月时间点的无事件患者被排除在外。结果：在3010例患者的队列中，1050例SRC EGA和424例患者符合选择标准。肿瘤主要位于胃（68.9%），218例（51.4%）患者行全胃切除术。术前71例（16.7%）和术后150例（35.4%）患者接受了放化疗或单纯化疗。中位随访54个月后，214例患者（50.5%）在平均延迟17 +/- 10.7个月内诊断出复发。PCR诊断81例（19.1%）。在多变量分析中，四个因素被确定为PCR的预测因子：（p < 0.001; OR = 4.83），肿瘤浸润腹膜浆膜或穿过腹膜浆膜（p = 0.022; OR = 1.58），淋巴结受累（p = 0.005; OR = 1.7）和胃源性肿瘤（p = 0.026; OR = 2.36），PCR阳性率分别为55%、26%、23%和22%。在这一大系列SRC EGA患者中确定PCR的强预测因子有助于确定可能受益于特定治疗策略（如预防性热腹腔内化疗）的患者亚组。(c)2012爱思唯尔有限公司保留所有权利。
Introduction: The poor prognosis of signet ring cell (SRC) eso-gastric adenocarcinoma (EGA) might be explained by its great affinity for the peritoneum. The aim of this study was to identify predictors of peritoneal carcinomatosis recurrence (PCR) after curative surgery and hence identify high risk patients.Methods: A retrospective national survey was conducted over 19 French surgical centers between 1997 and 2010. Patients with non-metastatic disease who benefited from curative surgery without postoperative death were included. Event-free patients who did not reach the time point of 24 months were excluded.Results: In a cohort of 3010 patients, 1050 were SRC EGA and 424 patients met the selection criteria. The tumor location was mainly gastric (68.9%) and a total gastrectomy was performed in 218 patients (51.4%). Chemoradiotherapy or chemotherapy alone was given pre-operatively to 71 (16.7%) and postoperatively to 150 (35.4%) patients. After a median follow-up of 54 months, recurrence was diagnosed in 214 patients (50.5%) within a mean delay of 17 +/- 10.7 months. PCR was diagnosed in 81 patients (19.1%). In multivariable analysis, four factors were identified as predictors of PCR: linitis plastica (p < 0.001; OR = 4.83), tumor invasion of/or through the peritoneal serosa (p = 0.022; OR = 1.58), lymph node involvement (p = 0.005; OR = 1.7) and tumors of gastric origin (p = 0.026; OR = 2.36), with PCR rates of 55%, 26%, 23% and 22%, respectively.Conclusion: Identification of strong predictors for PCR among this large series of SRC EGA patients helps to identify subgroups of patients that may benefit from specific therapeutic strategies such as prophylactic hyperthermic intraperitoneal chemotherapy. (c) 2012 Elsevier Ltd. All rights reserved.