GASTRIC-CANCER - A CURABLE DISEASE IN BRITAIN
GASTRIC-CANCER - A CURABLE DISEASE IN BRITAIN
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DOI：
10.1136/bmj.307.6904.591
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发表时间：
1993-09-04
影响因子：
105.7
通讯作者：
AXON, ATR
中科院分区：
文献类型：
--
作者：
SUELING, HM;JOHNSTON, D;AXON, ATR
目的：确定是否更积极的努力，旨在早期诊断结盟根治性手术切除导致胃癌患者的生存率提高。设计-前瞻性审计的所有情况下，胃癌治疗在1970年至1989年。设置-外科，综合医院。受试者-493例连续胃腺癌。主要结果测量-手术死亡率，术后发病率，结果：207例（42%）患者行潜在根治性切除术。所有患者中，这是可能的比例显着增加（p < 0.01），从31%，在第一个五年期间的53%，在过去的五年期间。早期胃癌患者的比例从1%上升到15%（p < 0.01），I期疾病从4%上升到26%（p < 0.001）。在潜在的治愈性切除后，术后30天的死亡率为6%。手术死亡率从1970年代的9%下降到1980年代的5%。同样，严重术后并发症的发生率从20世纪70年代的33%下降到20世纪80年代的17%（p < 0.01）。接受根治性切除术的患者的5年生存率为60%，早期胃癌患者为98%，I、II和III期疾病分别为93%、69%和28%。到20世纪80年代末，手术后5年生存率约为70%.Conclusions，这些研究结果表明，越来越多的胃癌患者可以在相对早期的病理阶段诊断时，约三分之二是可治愈的根治性手术。
Objective-To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved survival of patients with gastric cancer.Design-Prospective audit of all cases of gastric cancer treated during 1970-89.Setting-Department of surgery, general hospital.Subjects-493 consecutive patients with gastric adenocarcinoma.Main outcome measures-Operative mortality, postoperative morbidity, and five year survival after radical potentially curative resection.Results-207 (42%) patients underwent potentially curative resection. The proportion of all patients in whom this was possible increased significantly (p < 0.01) from 31% in the first five year period to 53% in the last five year period. The proportion of patients who had early gastric cancer rose from 1% to 15% (p < 0.01) and stage I disease rose from 4% to 26% (p < 0.001). After potentially curative resection, mortality 30 days after operation was 6%. Operative mortality decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the incidence of serious postoperative complications decreased from 33% in the 1970s to 17% in the 1980s (p < 0.01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%.Conclusions-These findings suggest that an increasing proportion of patients with gastric cancer could be diagnosed at a relatively early pathological stage when about two thirds are curable by means of radical surgery.