T2期胃癌术后复发因素分析

目的　探讨T2 期胃癌的临床病理学特性和影响术后复发的因素。　方法　将 12 4例接受了根治性手术的T2 期胃癌患者分为复发组和未复发组 ,对其临床资料、手术方式、病理结果以及术后累积生存率等进行对比分析。　结果　 2组患者年龄、性别、血型、手术方式、肿瘤大小及部位和组织学分化程度等情况 ,差异无显著性意义 (P >0 0 5 )。未复发组局限性溃疡型肿瘤占 45 1%、浅肌层肿瘤占 30 5 %、透肌层肿瘤占 2 5 6 % ,复发组分别占 2 6 2 %、4 8%、6 1 8% ,2组相比差异有显著性意义 (分别P <0 0 5、P <0 0 1)。复发组淋巴结转移率为 88 1% ,阳性淋巴结数为 (7 0 2± 6 5 0 )枚 ,未复发组分别为 5 7 3%、(2 16± 2 0 4)枚 ;复发组中位生存时间为 2 6 5个月 ,未复发组为 5 7 0个月 ;复发组 1、3、5年累积生存率分别为 6 1 4%、18 7%、8 3% ,未复发组分别为 97 6 %、95 9%、95 9% ,两者差异均有显著性意义 (P <0 0 1)。复发组局部复发占 5 4 8% ,远处转移占 46 2 %。　结论　T2 期胃癌患者一旦术后复发预后极差。肿瘤浸润程度、淋巴结转移状况是影响复发的重要因素。

Postoperative recurrence of T2 stage gastric cancer

OBJECTIVE: To study the clinicopathological characteristics of T(2) gastric cancer and its postoperative recurrence. METHOD: 124 T(2) gastric cancer patients were divided into two groups: 42 patients with postoperative recurrence (Group 1) and 82 patients without recurrence (Group 2). RESULTS: The recurrence rate of local tumor was significantly lower in Group 1 (26.2%) than in Group 2 (45.1%). Deep invasion was highly different between the two groups. Circular muscle tumors were seen in Group 1 (4.8%) and in Group 2 (30.5%), whereas sub-serosa tumors were seen in Group 1 (61.8%) and in Group 2 (25.6%). The rate of lymph node metastasis was significantly higher in Group 1 (88.1%) than in Group 2 (57.3%). The mean number of positive nodes was (7.02 +/- 6.50) in Group 1 and (2.16 +/- 2.04) in Group 2(P < 0.01). Local recurrence rate and distant metastasis rate in Group 1 were 54.8% and 46.2% respectively. The median survival was 26.5 months in Group 1 and 57.0 months in Group 2 (P < 0.01). The 1-, 3-, 5-year survival rate in Group 1 and Group 2 were 61.4% vs 97.6%, 18.7% vs 95.9%, and 8.3% vs 95.9%, respectively. CONCLUSION: Poor prognosis is seen in T(2) gastric cancer patients with postoperative recurrence. Extended gastrectomy and multi-therapy are necessary for the patients with the risk factors so as to decrease local recurrence.