中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
1期
43-47
,共5页
吴晖%徐萍萍%何裕隆%徐建波%蔡世荣%张信华%王亮%杨东杰%詹文华
吳暉%徐萍萍%何裕隆%徐建波%蔡世榮%張信華%王亮%楊東傑%詹文華
오휘%서평평%하유륭%서건파%채세영%장신화%왕량%양동걸%첨문화
胃肿瘤%病理学,临床%外科手术%预后%临床分期
胃腫瘤%病理學,臨床%外科手術%預後%臨床分期
위종류%병이학,림상%외과수술%예후%림상분기
Stomach neoplasms%Pathology,clinic%Surgical procedure,operative%Prognosis%Clinical staging
目的 评估目前横结肠系膜浸润胃癌T分期的合理性.方法 行手术治疗的T4期原发性胃癌808例,根据脏器浸润情况分为无浸润组(穿透浆膜的T4a期胃癌)638例,非系膜组(横结肠系膜以外单个脏器浸润的T4b期胃癌)126例,系膜组(仅横结肠系膜浸润)44例,比较3组患者的临床病理特征、手术方式和预后.结果 无浸润组、非系膜组和系膜组患者的性别、年龄、淋巴结转移率、肝转移率、肿瘤Borrmann分型、病理类型、分化程度、血清癌胚抗原水平比较,差异均无统计学意义(均P ＞0.05).无浸润组、非系膜组和系膜组患者的肿瘤直径≥5 cm者分别占39.0％、61.1％和54.5％,差异有统计学意义(P＜0.05).无浸润组、非系膜组和系膜组患者的远处转移率分别为11.9％、30.2％和43.2％,差异有统计学意义(P＜0.05).无浸润组、非系膜组和系膜组患者的腹膜种植转移率分别为8.2％、26.2％和38.6％,差异有统计学意义(P＜0.05).无浸润组、非系膜组和系膜组患者的Ⅳ期患者分别占25.4％、84.7％和93.7％,差异有统计学意义(P＜0.05).无浸润组、非系膜组和系膜组患者的根治性切除率分别为92.0％、69.8％和77.3％,差异有统计学意义(P＜0.05).系膜组的肿瘤直径、远处转移率、腹膜种植率、TNM分期和手术方式与无浸润组比较,差异均有统计学意义(均P＜0.0167);系膜组的肿瘤直径、远处转移率、腹膜种植率、TNM分期和手术方式与非系膜组比较,差异均无统计学意义(均P＞0.0167).无浸润组、非系膜组、系膜组患者的中位生存时间分别为42.0、16.4和19.0个月,差异有统计学意义(均P＜0.01);无浸润组患者的中位生存时间长于非系膜组和系膜组,差异均有统计学意义(均P＜0.01),非系膜组和系膜组患者的中位生存时间比较,差异无统计学意义(P＞0.05).肿瘤根治性切除后,无浸润组、非系膜组和系膜组患者的中位生存时间分别为47.9、23.5和21.4个月,差异有统计学意义(均P＜0.01);无浸润组的中位生存时间长于非系膜组和系膜组(均P＜0.05),非系膜组和系膜组患者的中位生存时间差异无统计学意义(P＞0.05).结论 横结肠系膜浸润胃癌患者的肿瘤直径、远处转移率、腹膜种植率、TNM分期、手术方式和预后与其他脏器浸润胃癌(T4b期)相似,而与T4a期胃癌不同,胃癌横结肠系膜浸润应列为T4b期.
目的 評估目前橫結腸繫膜浸潤胃癌T分期的閤理性.方法 行手術治療的T4期原髮性胃癌808例,根據髒器浸潤情況分為無浸潤組(穿透漿膜的T4a期胃癌)638例,非繫膜組(橫結腸繫膜以外單箇髒器浸潤的T4b期胃癌)126例,繫膜組(僅橫結腸繫膜浸潤)44例,比較3組患者的臨床病理特徵、手術方式和預後.結果 無浸潤組、非繫膜組和繫膜組患者的性彆、年齡、淋巴結轉移率、肝轉移率、腫瘤Borrmann分型、病理類型、分化程度、血清癌胚抗原水平比較,差異均無統計學意義(均P ＞0.05).無浸潤組、非繫膜組和繫膜組患者的腫瘤直徑≥5 cm者分彆佔39.0％、61.1％和54.5％,差異有統計學意義(P＜0.05).無浸潤組、非繫膜組和繫膜組患者的遠處轉移率分彆為11.9％、30.2％和43.2％,差異有統計學意義(P＜0.05).無浸潤組、非繫膜組和繫膜組患者的腹膜種植轉移率分彆為8.2％、26.2％和38.6％,差異有統計學意義(P＜0.05).無浸潤組、非繫膜組和繫膜組患者的Ⅳ期患者分彆佔25.4％、84.7％和93.7％,差異有統計學意義(P＜0.05).無浸潤組、非繫膜組和繫膜組患者的根治性切除率分彆為92.0％、69.8％和77.3％,差異有統計學意義(P＜0.05).繫膜組的腫瘤直徑、遠處轉移率、腹膜種植率、TNM分期和手術方式與無浸潤組比較,差異均有統計學意義(均P＜0.0167);繫膜組的腫瘤直徑、遠處轉移率、腹膜種植率、TNM分期和手術方式與非繫膜組比較,差異均無統計學意義(均P＞0.0167).無浸潤組、非繫膜組、繫膜組患者的中位生存時間分彆為42.0、16.4和19.0箇月,差異有統計學意義(均P＜0.01);無浸潤組患者的中位生存時間長于非繫膜組和繫膜組,差異均有統計學意義(均P＜0.01),非繫膜組和繫膜組患者的中位生存時間比較,差異無統計學意義(P＞0.05).腫瘤根治性切除後,無浸潤組、非繫膜組和繫膜組患者的中位生存時間分彆為47.9、23.5和21.4箇月,差異有統計學意義(均P＜0.01);無浸潤組的中位生存時間長于非繫膜組和繫膜組(均P＜0.05),非繫膜組和繫膜組患者的中位生存時間差異無統計學意義(P＞0.05).結論 橫結腸繫膜浸潤胃癌患者的腫瘤直徑、遠處轉移率、腹膜種植率、TNM分期、手術方式和預後與其他髒器浸潤胃癌(T4b期)相似,而與T4a期胃癌不同,胃癌橫結腸繫膜浸潤應列為T4b期.
목적 평고목전횡결장계막침윤위암T분기적합이성.방법 행수술치료적T4기원발성위암808례,근거장기침윤정황분위무침윤조(천투장막적T4a기위암)638례,비계막조(횡결장계막이외단개장기침윤적T4b기위암)126례,계막조(부횡결장계막침윤)44례,비교3조환자적림상병리특정、수술방식화예후.결과 무침윤조、비계막조화계막조환자적성별、년령、림파결전이솔、간전이솔、종류Borrmann분형、병리류형、분화정도、혈청암배항원수평비교,차이균무통계학의의(균P ＞0.05).무침윤조、비계막조화계막조환자적종류직경≥5 cm자분별점39.0％、61.1％화54.5％,차이유통계학의의(P＜0.05).무침윤조、비계막조화계막조환자적원처전이솔분별위11.9％、30.2％화43.2％,차이유통계학의의(P＜0.05).무침윤조、비계막조화계막조환자적복막충식전이솔분별위8.2％、26.2％화38.6％,차이유통계학의의(P＜0.05).무침윤조、비계막조화계막조환자적Ⅳ기환자분별점25.4％、84.7％화93.7％,차이유통계학의의(P＜0.05).무침윤조、비계막조화계막조환자적근치성절제솔분별위92.0％、69.8％화77.3％,차이유통계학의의(P＜0.05).계막조적종류직경、원처전이솔、복막충식솔、TNM분기화수술방식여무침윤조비교,차이균유통계학의의(균P＜0.0167);계막조적종류직경、원처전이솔、복막충식솔、TNM분기화수술방식여비계막조비교,차이균무통계학의의(균P＞0.0167).무침윤조、비계막조、계막조환자적중위생존시간분별위42.0、16.4화19.0개월,차이유통계학의의(균P＜0.01);무침윤조환자적중위생존시간장우비계막조화계막조,차이균유통계학의의(균P＜0.01),비계막조화계막조환자적중위생존시간비교,차이무통계학의의(P＞0.05).종류근치성절제후,무침윤조、비계막조화계막조환자적중위생존시간분별위47.9、23.5화21.4개월,차이유통계학의의(균P＜0.01);무침윤조적중위생존시간장우비계막조화계막조(균P＜0.05),비계막조화계막조환자적중위생존시간차이무통계학의의(P＞0.05).결론 횡결장계막침윤위암환자적종류직경、원처전이솔、복막충식솔、TNM분기、수술방식화예후여기타장기침윤위암(T4b기)상사,이여T4a기위암불동,위암횡결장계막침윤응렬위T4b기.
Objective To evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion.Methods Data of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University,from April 1996 to October 2009.According to the information of transverse mesocolon invasion,all cases were divided into groups NOI (T4a stage,non organ invasion,n =638),NTMI (T4b stage,non transverse mesolon invasion,with organ invasion,n =126),and TMI (transverse mesocolon invasion,n =44).The clinicopathological features,surgical procedure and prognosis were compared among the three groups.Results No significant difference was found in gender,age,lymph node metastasis,hepatic metastasis,tumor's Borrmann type,histological type,differentiation degree,value of serum CEA among the 3 groups (all P ＞ 0.05).In the groups NOI,NTMI and TMI,the ratio of mean tumor diameter ≥5 cm was 39.0％ (249/638),61.1％ (77/126) and 54.5％ (24/44),respectively; the ratio of distal metastasis was 11.9％ (76/638),30.2％ (38/126) and 43.2％ (19/44),respectively; the ratio of peritoneal metastasis was 8.2％ (52/638),26.2％ (33/126) and 38.6％ (17/44),respectively; the ratio of TNM Ⅳ stage was 25.4％ (162/638),84.7％ (107/126) and 93.7％ (41/44),respectively; and the ratio of radical resection was 92.0％ (587/638),69.8％ (88/126) and 77.3％ (34/44),respectively ; all with significant differences (P ＜0.01),and the results of pairwise comparisons (Bonferroni correction,significant level α =0.05/3 =0.0167) showed that these parameters were significantly different between groups NOI and TMI (P ＜0.0167),but non-significant between groups NTMI and TMI (P ＞0.0167).The median survival time was 42.0,16.4 and 19.0 months in the groups NOI,NTMI and TMI,respectively (P ＜ 0.01),and the results of pairwise comparison showed that the prognosis were significant different between the groups NOI and TMI (P ＜ 0.01),but non-significant between the groups NTMI and TMI (P ＞ 0.05).In the cases who received radical resection,the median survival time was 47.9,23.5 and 21.4 months in the groups NOI,NTMI and TMI,respectively (P ＜ 0.01),and the results of pairwise comparison showed that the prognosis was significantly different between the groups NOI and TMI (P ＜ 0.05),but not significant between groups NTMI and TMI (P ＞ 0.05).Conclusions The tumor size,distal meatastasis,peritoneal metastasis,TNM stage,surgical procedure and prognosis of gastric cancer with transverse mesocolon invasion are similar to that of T4b gastric cancer,but are significantly different from that of T4a gastric cancer.Gastric cancer with transverse mesocolon invasion should be reclassified as T4b stage.
