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目的:探讨胃体癌切除范围对预后的影响。方法:回顾性分析2003年4月―2008年4月157例行胃体癌根治性手术患者的临床资料和随访资料,其中行全胃切除术的患者104例(全胃组),行远端胃次全切除术53例(远端胃组),对比两组的5年生存率,分析胃体癌预后的独立影响因素。结果:全组患者5年生存率为37.6%,其中全胃组、远端胃组5年生存率分别为24.0%、64.2%,全胃组明显低于远端胃组(χ2=10.635,P=0.001);为消除两组术前基线资料的差异,将TNM分期分层对比的结果显示,低TNM分期患者中,远端胃组生存率明显高于全胃组(P<0.05),而高TNM分期患者中,两组生存率差异无统计学意义(P>0.05)。COX回归模型分析结果显示,TNM分期(HR=1.270,95%CI=1.093~2.344)、肿瘤分化程度(HR=1.764,95%CI=1.372~2.746)是胃体癌预后的独立影响因素(均P<0.05),而切除范围(HR=0.547,95%CI=0.320~1.076)不是胃体癌预后的独立影响因素(P>0.05)。结论:手术切除范围并非胃体癌预后的独立影响因素,在保证根治性的前提下远端胃次全切除术是更为适宜的术式。
Objective: To investigate the effect of excision of gastric cancer on prognosis. Methods: The clinical data and follow-up data of 157 patients with radical surgery of gastric cancer from April 2003 to April 2008 were retrospectively analyzed. Among them, 104 patients underwent total gastrectomy (total stomach group) Fifty-three cases of subtotal gastrectomy (distal gastric group) were enrolled in this study. The 5-year survival rates of the two groups were compared. The independent influencing factors on the prognosis of gastric cancer were analyzed. Results: The 5-year survival rate of all patients was 37.6%. The 5-year survival rates of the whole stomach group and the distal stomach group were 24.0% and 64.2% respectively, significantly lower than those in the distal stomach group (χ2 = 10.635, P = 0.001). To eliminate the difference of baseline data between the two groups, stratified TNM staging showed that in patients with low TNM stage, the survival rate of distal gastric group was significantly higher than that of the whole stomach group (P <0.05) In patients with high TNM stage, there was no significant difference in survival between the two groups (P> 0.05). COX regression model analysis showed that the TNM stage (HR = 1.270,95% CI = 1.093 ~ 2.344), tumor differentiation (HR = 1.764,95% CI = 1.372 ~ 2.746) were independent prognostic factors of gastric carcinoma 0.05). However, resection range (HR = 0.547, 95% CI = 0.320 ~ 1.076) was not an independent prognostic factor for gastric cancer (P> 0.05). Conclusion: The range of surgical resection is not an independent prognostic factor of gastric cancer. It is more appropriate to perform radical gastrectomy under the premise of radical treatment.