贲门癌预后多因素分析和术式对比研究

目的探讨贲门癌的临床特征和影响长期生存的预后因素,评价各种术式及辅助治疗的疗效。方法共收集２６３例贲门癌病例和随访资料,使用Ｌｏｇｉｓｔｉｃ回归和Ｌｏｇ－ｒａｎｋ检验等方法进行生存分析和术式对比研究。结果贲门癌患者男女比例为８．４１,女性平均年龄小于男性。分型中溃疡型、组织学分化程度较低类型比例小。性别、浸润深度、淋巴结受累程度是影响术后生存的预后因子。胃切除范围、淋巴结清扫程度和是否术前化疗,均未显示差异。扩大清扫术后并发症率高于一般清扫,而死亡率无差异。对于Ⅲ期Ｎ０～１患者,扩大清扫术后长期生存优于一般根治手术。结论贲门癌有独特的临床特征,治疗中应根据预后因子进行治疗方案的调整。对于较早期患者,推荐使用扩大清扫术。

Multivariate prognostic analysis of carcinoma of the gastric cardia and comparative study of different resections

OBJECTIVE: To evaluate the clinical characteristics and prognostic factors for long-term survival of patients with cancer of gastric cardia. METHODS: Logistic regression, log-rank test were used to analyze survival and evaluate the results of different resection procedures. RESULTS: Of the 263 patients, the male to female ratio was 8.4:1, the average age of female patients was younger than that of male patients. Sex, depth of invasion and lymph node involvement were prognostic factors of long-term survival. The extent of gastric resection and lymph node dissection, and pre-operative chemotherapy did not significantly affect survival. Higher frequency of postoperative complications was observed in patients received extended dissections, but did not affect survival. However, for patients in stage III N0-1, extended dissection resulted in longer survival than those received routine radical resection. CONCLUSION: Cancer of the gastric cardia has its own clinical characteristics. The surgical procedures should be adjusted according to the prognostic factors. For relatively early cases, extended dissection is recommanded.