CAJ | 학술논문

背景与目的:Ⅳ期胃癌在中国整体胃癌患者中仍占有较高比例,本文回顾性分析中国哈尔滨医科大学附属肿瘤医院手术胃癌患者的临床资料,探讨无远处转移的Ⅳ期胃癌患者手术、病理特点与预后的影响因素.方法:收集1993年1月至2004年8月哈尔滨医科大学附属肿瘤医院经手术治疗、病理确诊以及随访资料齐全的无远处转移的Ⅳ期胃癌病例630例.根治性手术338例,非根治手术292例.采用单因素和Cox回归分析预后的影响因素.结果:630例患者总的1、3、5年生存率分别为63.8%、31.4%和14.3%.单因素分析显示:1年预后的影响因素为Borrmann分型、淋巴结转移、脏器侵犯、肿瘤部位、肿瘤大小、病理分型、是否根治和联合脏器切除(P<0.05);Borrmann分型、淋巴结转移、脏器侵犯、病理分型和是否根治与3年预后显著相关(P<0.05);Borrmann分型、脏器侵犯和病理分型与5年预后相关(P<0.05).Cox回归分析显示仅病理分型是无远处转移的Ⅳ期胃癌患者5年预后的独立影响因素.结论:对于无远处转移的Ⅳ期胃癌患者行根治和联合脏器切除可延长其患者生存期,但还应结合化疗、放疗和靶向治疗等,制订合理的个体化治疗方案.
배경여목적:Ⅳ기위암재중국정체위암환자중잉점유교고비례,본문회고성분석중국합이빈의과대학부속종류의원수술위암환자적림상자료,탐토무원처전이적Ⅳ기위암환자수술、병리특점여예후적영향인소.방법:수집1993년1월지2004년8월합이빈의과대학부속종류의원경수술치료、병리학진이급수방자료제전적무원처전이적Ⅳ기위암병례630례.근치성수술338례,비근치수술292례.채용단인소화Cox회귀분석예후적영향인소.결과:630례환자총적1、3、5년생존솔분별위63.8%、31.4%화14.3%.단인소분석현시:1년예후적영향인소위Borrmann분형、림파결전이、장기침범、종류부위、종류대소、병리분형、시부근치화연합장기절제(P<0.05);Borrmann분형、림파결전이、장기침범、병리분형화시부근치여3년예후현저상관(P<0.05);Borrmann분형、장기침범화병리분형여5년예후상관(P<0.05).Cox회귀분석현시부병리분형시무원처전이적Ⅳ기위암환자5년예후적독립영향인소.결론:대우무원처전이적Ⅳ기위암환자행근치화연합장기절제가연장기환자생존기,단환응결합화료、방료화파향치료등,제정합리적개체화치료방안.
Background and Objective: The proportion of stage Ⅳ gastric cancer in the whole gastric cancer population in China is still high.This study was to investigate the surgery and pathologic characteristic and prognostic factors of stage Ⅳ(MO)gastric cancer.Methods: Clinical data of 630patients with pathologically confirmed stage Ⅳ(MO)gastric cancer treated at the Affiliated Tumor Hospital of Harbin Medical University between January1993 and August 2004 were analyzed using Cox proportional hazard model.Of the 630 patients,338 received radical excision and 292 received palliative resection.Results.The overall 1-,3-,and 5-year survival rates were 63.8%,31.4%,and 14.3%,respectively.Univariate analysis showed that Borrmann type,lymphatic metastasis,organ involvement,tumor location,tumor size,pathologic type,radical excision,and other organ excision were significant prognostic factors affecting 1-year survival rate(P<0.05); Borrmann type,lymphatic metastasis,organ involvement,pathologic type,and radical excision affected 3-year survival rate(P<0.05); only organ involvement and pathologic type affected 5-year survival rate(P<0.05).Multivariate analysis showed that pathologic type was independent prognostic factor for poor survival.Conclusions.Radical resection and combined organ resection could prolong the survival of stage Ⅳ(MO)gastric cancer patients.Chemotherapy,radiotherapy and targeted therapy should be considered for individual therapeutic regimen.