Prognostic factors for patients after curative resection for proximal gastric cancer
Tóm tắt
The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, <10%, 10%–30% and >30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (χ
2=4.57, P=0.0325), gross type (χ
2=21.38, P<0.001), T stage (χ
2=27.91, P<0.001), pN stage (χ
2=44.72, P<0.001), MLR (χ
2=61.12, P<0.001), TNM stage (χ
2=44.91, P<0.001), and range of gastrectomy (χ
2=4.36, P=0.0368). Multivariate analysis showed that MLR (χ
2=10.972, P=0.001), pN stage (χ
2=6.640, P=0.010), TNM stage (χ
2=7.081, P=0.007), T stage (χ
2=7.687, P=0.006) and gross type (χ
2=6.252, P=0.012) were the independent prognostic factors. In addition, the prognosis of patients who underwent total gastrectomy (TG) was superior to that of patients who underwent proximal gastrectomy (PG) for the cases of tumor ≥5 cm (χ
2=6.31, P=0.0120), Borrmann III/IV (χ
2=7.96, P=0.0050), T4 (χ
2=4.57, P=0.0325), pN2 (χ
2=5.52, P=0.0188), MLR 10%–30% (χ
2=4.46, P=0.0347), MLR >30% (χ
2=13.34, P=0.0003), TNM III (χ
2=14.05, P=0.0002) or TNM IV stage (χ
2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (χ
2=5.68, P=0.0171) or MLR >30% (χ
2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.
Tài liệu tham khảo
Volpe CM, Driscoll DL, Douglass HO Jr. Outcome of patients with proximal gastric cancer depends on extent of resection and number of resected lymph nodes. Ann Surg Oncol, 2000,7(2):139–144
Kim JH, Park SS, Kim J, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg, 2006,30(10):1870–1876
Craanen ME, Dekker W, Blok P, et al. Time trends in gastric carcinoma: changing patterns of type and location. Am J Gastroenterol, 1992,87(5):572–579
Siewert JR, Böttcher K, Stein HJ, et al. Problem of proximal third gastric carcinoma. World J Surg, 1995,19(4):523–531
Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol, 2006,12(3):354–362
Jacob CE, Gama-Rodrigues J, Bresciani CJ, et al. Trends in tumor location in gastric carcinoma over a 28-year period. Hepatogastroenterology, 2007,54(76):1297–1301
Huang CM, Lin BJ, Lu HS, et al. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol, 2008,14(27):4383–4388
Piso P, Werner U, Lang H, et al. Proximal versus distal gastric carcinoma — what are the differences? Ann Surg Oncol, 2000,7(7):520–525
Pacelli F, Papa V, Caprino P, et al. Proximal compared with distal gastric cancer: multivariate analysis of prognostic factors. Am Surg, 2001,67(7):697–703
Kunisaki C, Shimada H, Ono HA, et al. Comparison of results of surgery in the upper third and more distal stomach. J Gastrointest Surg, 2006,10(5):718–726
Yu W, Chio GS, Chung HY. Randomized clinical trial of splenectomy versus preservation in patients with proximal gastric cancer. Br J Surg, 2006,93(5):559–563
Kunisaki C, Shimada H, Nomura M, et al. Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach. Surgery, 2005,137(2):165–171
Kunisaki C, Makino H, Suwa H, et al. Impact of splenectomy in patients with gastric adenocarcinoma of the cardia. J Gastrointest Surg, 2007,11(8):1039–1044
Monig SP, Collet PH, Baldus SE, et al. Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol, 2001,76(2):89–92
Sakaguchi T, Sawada H, Yamada Y, et al. Indication of splenectomy for gastric carcinoma involving the proximal part of the stomach. Hepatogastroenterology, 2001,48(38): 603–605
Zhang XF, Huang CM, Lu HS, et al. Surgical treatment and prognosis of gastric cancer in 2613 patients. World J Gastroenterol, 2004,10(23):3405–3408
Sobin LH, Fleming ID. TNM Classification of Malignant Tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer, 1997,80(9):1803–1804
Li K, Xu HM, Chen JQ. Relationship between metastatic rate and amount of lymph nodes and prognosis of gastric cancer. Zhonghua Yi Xue Za Zhi (Chinese), 2005,85(30): 2113–2116
Yokota T, Ishiyama S, Saito T, et al. Lymph node metastasis as a significant prognostic factor in gastric cancer: a multiple logistic regression analysis. Scand J Gastroenterol, 2004,39(4):380–384
Wu ZY, Li JH, Zhan WH, et al. Effect of lymph node micrometastases on prognosis of gastric carcinoma. World J Gastroenterol, 2007,13(30):4122–4125
Higashi H, Natsugoe S, Ishigami S, et al. Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion. World J Surg, 2003,27(4):455–459
Ding YB, Chen GY, Xia JG, et al. Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of patients with surgically-removed gastric carcinoma. World J Gastroenterol, 2004,10(2):182–185
Nitti D, Marchet A, Olivieri M, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol, 2003,10(9):1077–1085
Yu JX, Wu YL, Yang LT. The value of metastatic lymph nodes ratio in predicting the prognosis of patients with T3 gastric carcinoma. Zhonghua Yi Xue Za Zhi (Chinese), 2005, 85(13):922–925
Shiraishi N, Adachi Y, Kitano S, et al. Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg, 2002,26(9):1150–1154
Isgüder AS, Nazli O, Tansug T, et al. Total gastrectomy of gastric carcinoma. Hepatogastroenterology, 2005,52(61): 302–304
Zhang XF, Lu HS, Yin FZ. A comparative study of therapeutic effects of total versus proximal subtotal gastrectomy in adenocarcinoma of the gastric cardia. Zhonghua Zhong Liu Za Zhi (Chinese), 1994,16(6):447–450
Erturk S, Ersan Y, Cicek Y, et al. Effect of simultaneous splenectomy on the survival of patients undergoing curative gastrectomy for proximal gastric carcinoma. Surg Today, 2003,33(4):254–258
Lee KY, Noh SH, Hyung WJ, et al. Impact of splenectomy for lymph node dissection on long-term surgical outcome in gastric cancer. Ann Surg Oncol, 2001,8(5):402–406
Csendes A, Burdiles P, Rojas J, et al. A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma. Surgery, 2002,131(4):401–407
Weitz J, Jaques DP, Brennan M, et al. Association of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer. Ann Surg Oncol, 2004,11(7):682–689
Ikeguchi M, Kaibara N. Lymph node metastasis at the splenic hilum in proximal gastric cancer. Am Surg, 2004, 70(7):645–648
Ohno M, Nakamura T, Ajiki T, et al. Procedure for lymph node dissection around splenic artery in proximal gastric cancer. Hepatogastroenterology, 2003,50(52):1173–1177