Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study
Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study
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DOI：
10.1007/s10120-015-0589-6
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发表时间：
2017-01-01
期刊：
影响因子：
7.4
通讯作者：
Orsenigo, Elena
中科院分区：
文献类型：
--
作者：
Bissolati, Massimiliano;Desio, Matteo;Orsenigo, Elena
背景：胃切除术后切除缘受累与不良预后相关。术中冷冻切片（IFS）分析可以在一次手术中实现根治性切除，但耗时且耗费资源。本研究的目的是评估与RM相关的风险因素，以确定将从IFS分析中受益的患者。我们回顾性分析了意大利6家医院2000年至2014年因胃或食管胃交界（EGJ）癌接受胃切除术的患者。通过IFS分析和/或明确的组织病理学检查评估RM状态。通过多因素分析比较IFS分析或明确组织病理学检查RMs阳性患者与RMs阴性的对照组患者的21个潜在危险因素，并将样本分为三个亚组（T1、T2-T4 Lauren肠型、T2-T4 Lauren弥漫性/混合型）。145例患者的RMs呈阳性。RM阳性患者的生存期明显低于RM阴性患者（89.5个月vs 28.9个月）。多变量分析表明,在T1癌症的边缘距离小于2厘米RM的参与是一个风险因素(优势比15.7),在T2-T4肠道模式癌症,浆膜入侵(优势比6.0),EGJ位置(优势比4.1),和一个边缘的距离小于3厘米(优势比4.0)是独立的危险因素,在癌症T2-T4分散/混合模式,淋巴浸润(优势比4.2),肿瘤直径大于4厘米(优势比3.5),EGJ位置(优势比2.8),浆膜侵犯（优势比2.2）是独立的危险因素。胃切除术后的生存受到阳性RMs的负面影响。IFS分析应常规用于RMs阳性风险高的患者，特别是弥漫性癌症。
Background Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time-consuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis.We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern).One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors.Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.