PATTERNS OF FAILURE FOLLOWING CURATIVE RESECTION OF GASTRIC-CARCINOMA
PATTERNS OF FAILURE FOLLOWING CURATIVE RESECTION OF GASTRIC-CARCINOMA
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DOI：
10.1016/0360-3016(90)90344-j
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发表时间：
1990-12-01
影响因子：
7
通讯作者：
SULLINGER, J
中科院分区：
文献类型：
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作者：
LANDRY, J;TEPPER, JE;SULLINGER, J
为了确定胃癌根治性切除后失败的模式，我们回顾了在马萨诸塞州总医院接受根治性切除的130例患者的记录。总的局部失败率为38%(49/130例)，其中21例为单纯局部失败者，28例为局部失败者和远处转移者。随着疾病的进展，局部衰竭的发生率也随之上升。分期为B2、B3、C2和C3的肿瘤局部区域失败率超过35%。这组患者可能受益于肿瘤床和区域淋巴管的辅助放射治疗。局部失败率以吻合口或残端最高(25%)，其次为胃床27/130(21%)。远处转移的总发生率为52%(67/130例患者)，并在疾病越严重的阶段上升。分期为B2、B3、C2和C3的肿瘤远处转移率大于50%。61名患者(77%)腹部(肝、腹膜表面、肾上腺、肾脏和脾)衰竭，但不包括肿瘤床、吻合口或区域结节。B2、B3、C2和C3期肿瘤患者的总腹衰率超过40%。肝脏失败率最高的是B3期和C3期，继发肝转移分别为40%和47%。腹膜种植发生率为23%(30/130)，以C2期和C3期最高，分别为27%和41%。
To identify patterns of failure following curative resection of gastric carcinoma, the records of 130 patients undergoing resection with curative intent at the Massachusetts General Hospital were reviewed. The total local-regional failure rate was 38% (49/130 patients), with 21 patients having local-regional failure alone and 28 patients having local-regional failure and distant metastases. The incidence of local failure rose with the more advanced stages of disease. Tumors staged B2, B3, C2, and C3 had local-regional failure rates in excess of 35%. This group of patients might benefit from adjuvant radiation therapy to the tumor bed and regional lymphatics. Local-regional failure rate was highest in the anastomosis or stump 33/130 (25%), followed by the stomach bed 27/130 (21%). The overall incidence of distant metastases was 52% (67/130 patients) and rose in the more advanced disease stages. Tumors staged B2, B3, C2, and C3 had rates of distant metastases greater than 50%. Sixty-one patients (77%) had failure in the abdomen (liver, peritoneal surface, adrenal, kidney, and spleen, but excluding tumor bed, anastomosis, or regional nodes). Patients with Stage B2, B3, C2, and C3 tumors had total abdominal failure rates greater than 40%. The highest failure rates in the liver were in Stages B3, and C3, in which the subsequent development of liver metastasis was 40% and 47%, respectively. Peritoneal seeding occurred in 30/130 (23%) of patients and was highest in Stages C2 and C3, with rates of 27% and 41%, respectively.