Proximal gastric cancers resected via a transabdominal-only approach - Results and comparisons to distal adenocarcinoma of the stomach
Proximal gastric cancers resected via a transabdominal-only approach - Results and comparisons to distal adenocarcinoma of the stomach
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DOI：
10.1097/00000658-199706000-00005
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发表时间：
1997-06-01
影响因子：
9
通讯作者：
Brennan, MF
中科院分区：
文献类型：
--
作者：
Harrison, LE;Karpeh, MS;Brennan, MF
本研究的目的是比较近端胃癌（PGC）患者经腹切除术与远端胃癌（DGC）患者经腹切除术的结果。与DGC相比，PGC的生存率更差，部分原因可能是PGC与食管远端腺癌难以区分。通过定义仅经腹切除的PGC子集，可以区分真正的PGC和远端食管腺癌。这一子集的患者是一个更合适的比较组，当分析结果相对于DGC的患者。MethodsA回顾的前瞻性数据库胃腺癌纪念斯隆-凯特琳癌症中心1985年7月至1995年8月确定了98例PGC切除术通过transabdominal-only的方法。其中，65例接受了近端胃切除术，33例接受了全胃切除术。对于DGC，258需要远端胃切除术和71需要全胃切除术。结果与PGC患者的总体5年生存率为42%（中位生存期，47个月），而与DGC患者的5年生存率为61%（中位生存期，106个月，P = 0.03）。在每个阶段内，没有显著的生存差异，但在所有阶段，DGC患者的生存率更好。更重要的是，原发性肿瘤的网站似乎影响生存，随着肿瘤的移动proximately.ConclusionsDespite排除远端食管癌，PGC患者的生存仍然比DGC的那些更糟糕的结果。晚期的表现不能解释这种差异。似乎PGCs天生比DGCs更具攻击性。此外，原发肿瘤的部位似乎影响预后，随着肿瘤向近端移动，预后有恶化的趋势。
ObjectiveThe purpose of this study is to compare the outcome of patients with proximal gastric cancer (PGC) treated by a transabdominal-only resection to that of patients with distal gastric cancer (DGC).Summary Background DataIt has been suggested that PGC is inherently more aggressive than DGC. The worse survival oi PGC compared with that of DGC may be, in part, because of the difficulty distinguishing PGC from distal esophageal adenocarcinoma. By defining a subset of PGC resected using an transabdominal-only approach, one may discriminate true PGC from distal esophageal adenocarcinoma. This subset of patients is a more appropriate comparison group when analyzing outcome relative to patients with DGC.MethodsA review of the prospective database for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center between July 1985 and August 1995 identified 98 patients with PGC resection via a transabdominal-only approach. Of these, 65 underwent proximal gastrectomy and 33 underwent total gastrectomy. For DGC, 258 required a distal gastrectomy and 71 required total gastrectomy.ResultsThe overall 5-year survival of patients with PGC was 42% (median survival, 47 months), whereas the 5-year survival for patients with DGC was 61% (median survival, 106 months, p = 0.03). Within each stage, there were no significant survival differences, but in ail stages, survival was better for patients with DGC. More important, the site of the primary tumor appears to affect survival, with a worse outcome as the tumor moves proximally.ConclusionsDespite excluding distal esophageal cancers, survival for patients with PGC remains worse than for those with DGC. Late stage of presentation could not explain this difference. it appears that PGCs are inherently more aggressive than are DGCs. In addition, site of the primary tumor appears to affect outcome, with a trend toward a worse outcome as the tumor moves proximally.