Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer
Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer
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DOI：
10.1016/s1072-7515(03)00539-8
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发表时间：
2003-08-01
影响因子：
5.2
通讯作者：
Yonemura, Y
中科院分区：
文献类型：
--
作者：
Bando, E;Kawamura, T;Yonemura, Y
背景：腹膜播散是胃癌患者最常见的复发方式。我们试图找出预测腹膜复发的因素与高sensitivity.Study设计：回顾性分析了587例胃癌患者的临床和病理资料。逐步考克斯比例风险回归模型用于评估血清学变化幅度的预后意义。采用多元逐步Logistic回归分析确定375例接受根治性切除术患者腹膜复发的相关因素。S2期患者的5年生存率（肉眼可见锯齿变化的最大尺寸大于或等于2.5 cm）为18%，与SO（无血清学改变）和S1病（肉眼血清学改变<2.5cm）相比，差异有显著性（p < 0.001）。接受根治性切除术的SO肿瘤患者的5年生存率最高。多变量分析表明，血清学变化的幅度是一个独立的预后因素生存的整体和根治性切除术后。Logistic回归分析显示，腹膜复发的可能性是S2比SO或S1肿瘤的4倍多。结论：胃癌术中血清学改变的程度易于测量，其预测腹腔复发的敏感性高于常规腹腔灌洗细胞学检查。(C)2003年由美国外科医生学会。
BACKGROUND: Peritoneal dissemination is the most frequent mode of recurrence in patients with gastric cancer. We tried to identify factors that predict peritoneal recurrence with high sensitivity.STUDY DESIGN: Clinical and pathologic data from 587 consecutive patients with gastric cancer were reviewed retrospectively. The stepwise Cox proportional hazards regression model was used to assess the prognostic significance of the magnitude of serosal changes. Multiple stepwise logistic regression analysis was used to determine factors associated with peritoneal recurrence in 375 patients who underwent curative resection.RESULTS: The 5-year survival rate of patients with S2 disease (greatest dimension of macroscopic serosal changes greater than or equal to 2.5 cm) was 18%, which was worse than SO (no serosal changes) and S1 disease (macroscopic serosal changes < 2.5 cm) (p < 0.001). Patients with SO tumors who underwent curative resection had the best 5-year survival rate. Multivariate analyses indicated that the magnitude of serosal changes was an independent prognostic factor for survival both overall and after curative resection. Logistic regression analysis showed that peritoneal recurrence was more than four times as likely with S2 than with SO or S1 tumors. The sensitivity for predicting peritoneal recurrence was 79%; the sensitivity of cytologic examination was 38%.CONCLUSIONS: Magnitude of serosal changes is easy to measure intraoperatively and predicts peritoneal recurrence of gastric cancer with greater sensitivity than conventional peritoneal lavage cytology. (C) 2003 by the American College of Surgeons.