77例胃的黏膜相关淋巴组织淋巴瘤的临床分析

目的 回顾分析原发于胃的黏膜相关淋巴组织淋巴瘤(MALT)的治疗结果、预后因素和失败类型.方法 搜集20余年间收治的原发胃MALT淋巴瘤病例,病理证实且为Ⅰ、Ⅱ、ⅡE期.77例患者进入分析,手术切除组60例(手术14例、手术+化疗32例、手术+化放疗4例、手术+放疗9例、化疗+手术+化疗1例),非手术切除组17例(化放疗11例、化疗5例、放疗1例).放疗采用常规放疗(20例)和三维适形放疗(5例).化疗采用CHOP、BACOP或COP方案(53例).结果 随访1～198个月,中位值57个月.全组患者5年总生存率为74%,5年无瘤生存率为70%,5年局部控制率为76%,5年无远处失败生存率为87%.单因素分析显示临床分期与总生存率显著相关(P=0.02),肿瘤大小(P=0.03)和手术程度(P=0.02)与无瘤生存率显著相关,临床分期(P=0.04)、肿瘤大小(P=0.01)和手术程度(P=0.03)与局部控制率显著相关,未发现与无远处失败生存率显著相关因素.Ⅰ、Ⅱ期患者手术治疗后失败主要在远处,非手术治疗患者的失败主要在局部.ⅡE期患者,无论手术组还是非手术组,失败主要在局部.结论 胃原发黏膜组织相关淋巴瘤采用手术和非手术治疗均可取得很好的治疗效果,临床分期是非常重要的预后因素.     

胃癌组织Beclin1表达与幽门螺杆菌感染的相关性

目的:探讨胃癌组织自噬相关蛋白Beclin1的表达和临床意义,及与幽门螺杆菌(HP)感染的相关性.方法:应用免疫组化法检测120例胃癌和配对正常胃组织中自噬相关蛋白Beclin1的表达;分析Beclin1的表达和临床病理学参数的关系;分析Beclin1的表达和无疾病进展生存(disease free survival,DFS)的相关性;应用碳14呼气试验检测胃癌患者幽门螺杆菌的感染,并分析Beclin1的表达和HP感染的相关性.结果:Beclin1在胃癌和正常胃组织的高表达率分别为59.2%(71/120)、36.7%(44/120),胃癌组织Beclin1的高表达率显著高于正常胃组织,差异有统计学意义(P=0.004).Beclin1的高表达与胃癌患者pTNM分期(P<0.001)和区域淋巴结转移(P<0.001)有显著负相关性.与Beclin1高表达的患者比较,Beclin1低表达患者的中位DFS显著缩短(21 vs 25个月,P=0.032).HP阳性胃癌组织的Beclin1高表达率显著高于HP阴性者(71.0%vs 43.1%,P=0.002);Spearmen相关性检验显示HP感染和Beclin1表达有显著相关性(γ=0.280,P=0.002);logistic回归分析显示HP感染对Beclin1表达有显著影响(P=0.009).结论:胃癌组织Beclin1表达水平增高;Beclin1高表达提示较好的预后;HP感染与Beclin1表达有显著相关性.     

Incidence and Prognostic Significance of Proteinuria in Patients with Gastric Carcinoma

OBJECTIVE The present study was designed to evaluate the epidemiological and prognostic significance of proteinuria in patients with gastric cancer (GC).METHODS We retrospectively reviewed the frequency of proteinuria in patients with GC and analyzed its relationship with the GC biological characteristics, treatment and survival.RESULTS Proteinuria incidence in GC patients was 24.06%, which was significantly higher than that found in a control group (P＜0.01); the frequency of proteinuria was significantly correlated with an advanced disease stage(P＜0.01). We also found that the post-treatment mean value of proteinuria was remarkably lower than the pre-treatment value (P＜0.001). KaplanMeier analysis revealed a significant correlation between proteinuria and survival of GC patients (P＜0.05). Multivariate analysis demonstrated that the TNM stage, lymph node status and proteinuria may serve as independent prognostic markers in patients with GC (P ＜0.01).CONCLUSION A high prevalence of increased urinary protein excretion was observed in GC patients complicated with nephritis. Proteinuria may be used as one of the prognostic markers for patients with GC.     

RNF144B在胃癌组织中的表达及其与患者预后的关系

目的:探讨环指蛋白144B（ring finger protein 144B,RNF144B）在胃癌组织中的表达水平及其与胃癌患者临床预后的关系。方法:回顾性分析2013年1月-2014年1月在兰州大学第二医院确诊并行根治性手术治疗的胃癌患者的临床资料;我们的研究一共纳入了105名患者,记录患者的TNM分期、肿瘤大小、分化水平、癌胚抗原（carcino-embryonic antigen,CEA）等指标并记录患者的总体生存时间（overall survival,OS）;利用免疫组织化学染色（immunohistochemistry,IHC）检测RNF144B在胃癌及癌旁组织中的表达,并分析其与患者一般临床病理特征的联系;应用Cox回归模型评估患者术后总体生存时间的影响因素;使用Kaplan-Meier Plotter数据库对RNF144B进行生存相关性分析,随后利用临床数据进行验证。结果:RNF144B在胃癌组织中显著高表达（P=0.003 9）,RNF144B高表达组的患者CEA水平、Ki67阳性率、临床病理分期、T分期均显著高于低表达组,而分化程度差于低表达组（P＜0.05）;多因素分析显示RNF144B高表达、肿瘤分化程度低、临床病理分期高均是影响胃癌患者术后总体生存时间的独立因素（P＜0.05）;Kaplan-Meier法分析得RNF144B高表达组术后5年生存率（6.06%）低于低表达组（29.69%）（P＜0.01）。结论:RNF144B在胃癌中高表达并标志着更差的临床预后。     

A trial of adjuvant combination chemoimmunotherapy for stage III carcinoma of stomach

A chemoimmunotherapy program designed on the basis of experimental results was administered to 27 patients with stage III carcinoma of stomach following curative resection. The treatment regimen consisted of active immunotherapy with Vibrio cholerae neuraminidase (VCN)-treated autologous tumor cells admixed with bacillus Calmette-Guérin (BCG) and chemotherapy with drugs such as cyclophosphamide (CY), mitomycin C (MMC), and 5-fluorouracil (FU) which proved to enhance the immune response when administered at optimal dose and timing. Then, it was followed by long-term administration of tegafur (FT) and immunomodulators. This treatment significantly improved survival when compared to that of 41 historical control patients treated with surgery alone (P less than 0.001). As compared to 31 control patients concurrently treated with a bolus dose of MMC followed by long-term FT and immunomodulators, survival had a tendency, but not significantly, to be improved in patients treated with this therapy (P less than 0.1). However, the survival rate at 4.5 years was significantly higher than that of control patients (P less than 0.01). These results appeared to show that this type of adjuvant combination chemoimmunotherapy may be of benefit for this group of patients with gastric carcinoma.     

Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups?

BACKGROUND: Patients who present with stage IV gastric cancer are not commonly managed with surgical resection as effective palliation can usually be accomplished with systemic chemotherapy, endoscopic stenting, or surgical bypass procedures. Given the inherent morbidity and mortality associated with gastrectomy, palliative resection for stage IV gastric cancer should be reserved for ideal surgical candidates who are most likely to benefit from the procedure. The purpose of this study is to review outcomes following resection for stage IV gastric cancer, and to identify criteria predictive of improved outcomes following gastrectomy in this setting. METHODS: A retrospective review of a prospective GI oncology database was conducted. Sixty-three patients with stage IV gastric cancer managed with surgical resection between 1989 and 2001 were identified. Variables including demographic data, patterns of distant spread (ex: peritoneal, lymphatic, hematogenous), location of tumor, and type of gastrectomy were utilized to conduct survival analyses. RESULTS: Actuarial survival for all patients at one and 3-year intervals was 52% and 12%, respectively. Improved survival was observed for patients of East Asian race (median survival 20 vs. 12 months, P < 0.05, students t-test) and age less than 60 years (median survival 15 vs. 12 months, P < 0.05). This trend was also illustrated by Kaplan-Meier survival analysis. Other variables including pattern of distant spread, location of tumor, and type of gastrectomy were not associated with a significant difference in survival. Both East Asian race and age less than 60 years were statistically significant predictors of improved survival when assessed by univariate regression analysis. When variables were analyzed in a multivariate regression analysis, Asian race and age <60 both lost their statistical significance as independent predictors of improved survival. CONCLUSIONS: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Patient specific variables including East Asian race and age less than 60 years appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. However, multivariate regression analysis failed to demonstrate these factors as independent predictors of improved outcome. In conclusion, highly selected acceptable risk surgical candidates with stage IV gastric cancer should be considered for management with surgical resection in clinically appropriate scenarios.     

中青年与老年胃癌术后患者的临床病理特点和预后因素—基于SEER数据库的分析

目的:比较中青年与老年胃癌患者的临床病理特征,分析胃癌根治术后影响中青年和老年胃癌患者长期生存的预后因素。方法:选取SEER数据库经胃癌根治手术治疗后的胃癌患者,用方差分析分析胃癌不同原发部位的肿瘤大小差异,采取COX比例风险模型、卡方检验和Kaplan-meier法,对患者资料进行分析。结果:两组胃癌患者在性别、组织学类型、T分期、分化程度、婚姻情况等方面比较,差异均有统计学意义（P＜0.05）。与老年胃癌组相比,中青年胃癌组中男性发生率高,出现印戒细胞癌的比例高,且低分化或未分化所占比例都高于老年胃癌组。年龄是影响胃癌根治术后患者生存期的独立危险因素。种族、肿瘤原发部位、T、N、M分期、肿瘤大小均是影响中青年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响中青年胃癌患者生存期的独立危险因素（P＜0.05）。种族、肿瘤原发部位、分化程度、组织学类型、T、N、M分期、肿瘤大小、婚姻情况均是影响老年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响老年胃癌患者生存期的独立危险因素（P＜0.05）。胃癌不同原发部位的肿瘤大小之间的差异无统计学意义（P＞0.05）。结论:年龄与胃癌的临床病理特征关系密切,不同年龄具有不同发病特点,且年龄是影响胃癌根治术后患者生存期的独立危险因素。淋巴结的转移度、肿瘤的侵犯深度、肿瘤的大小、远处转移均是中青年和老年胃癌患者预后的重要因素,强调早诊早治,是提高胃癌患者预后的关键。     

RhoA在胃癌细胞核中的表达及预后意义

[目的]探讨RhoA蛋白在胃癌细胞核中的表达及预后意义。[方法]选取有详细临床资料的胃癌组织179例及正常胃黏膜组织80例,应用免疫组织化学改良二步法检测RhoA蛋白的胞核表达。[结果]RhoA蛋白在胃癌及正常胃黏膜组织细胞核中的表达阳性率分别为69.8%(125/179)和25.0%(20/80),差异有显著性(P<0.05)。RhoA蛋白胞核表达率与胃癌肿瘤分化、TNM分期、淋巴结转移有关(P<0.05)。RhoA胞核阳性患者的术后生存期短于阴性患者(P=0.022)。Cox风险比例模型表明,RhoA胞核阳性是胃癌术后预后的独立指标(OR=3.09,P=0.005)。[结论]RhoA蛋白在胃癌细胞核中过表达,是判断胃癌患者术后生存期的独立预后指标。     

Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer

BACKGROUND: For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage. METHODS: The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients. RESULTS: Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P < .001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81% vs 25%; P < .01). CONCLUSIONS: Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.     

ERK5在胃癌中的表达及临床意义

目的:分析细胞外信号调节激酶5（ERK5）在胃癌及癌旁正常黏膜组织中的表达情况及其与胃癌临床病理参数的关系,探讨ERK5的临床意义。方法:采用免疫组织化学方法检测80例胃癌组织和35例癌旁正常组织中ERK5的表达,分析ERK5表达与胃癌临床病理参数及预后的相关性。结果:35例癌旁正常组织中,ERK5低表达29例（82.9%）、高表达6例（17.1%）;80例胃癌组织中ERK5低表达51例（63.8%）、高表达29例（36.3%）;两者中ERK5蛋白表达有显著有统计学意差异（P＜0.05）。在80例胃癌组织中,癌组织中ERK5蛋白的表达水平与淋巴结转移和临床分期有关（P＜0.05）,与患者性别、年龄、肿瘤浸润深度和分化程度无明显相关性（均P＞0.05）。生存分析显示,胃癌组织中ERK5高表达的患者总体5年生存率明显低于低表达组。结论:ERK5可能是一个促进肿瘤转移的因子。     

Usefulness of polysaccharide K (PSK) as postoperative adjuvant immunotherapy in patients with stage IV gastric cancer

Background. We investigated retrospectively the usefulness of polysaccharide K (PSK) administration for prolonging survival after noncurative resection in patients with stage IV gastric cancer who underwent surgery at our department. Methods. 357 patients with gastric cancer evaluated as stage IV according to thegeneral rules for gastric cancer study, 11th edn (1985) of the Japanese Research Society for Gastric Cancer, who were expected to succumb to surgical death or postoperative death within 2 months were studied. The patients were divided into two groups: total PSK dosage greater than or less than 180g. Survival rates were calculated for each group. Results. In these stage-IV gastric cancer patients, the 5-year and 10-year survival rates in the PSK group were both 13.9%. In the non-PSK group, the rates were 8.7% and 7.0%, respectively. The survival rates were significantly higher in the PSK group (p = 0.0001). The survival rate was also calculated with respect to the staging factors. Patients in the PSK group who had H0, P0, se or milder and n3 or n4 showed a significantly higher survival rate than those with these staging factors in the non-PSK group (p = 0.010). Conclusion. PSK administration prolonged survival in stage-IV gastric cancer patients, the effect being marked in patients with severe lymph node metastasis. We suggest that be administered as adjuvant therapy in stage-IV gastric cancer patients with severe lymph node metastasis (n3, n4).     

Mortality for gastric cancer in elderly patients

BACKGROUND: The aim of this study was to clarify the surgical outcome in elderly patients with gastric cancer. METHODS: The clinicopathological features of elderly patients (80 (3.7%), over 80 years, elderly group) were reviewed retrospectively and compared with those of younger patients (2095 (96.3%), 23-79 years, control group). RESULTS: The elderly group had a significantly higher prevalence of concomitant disease (P < 0.0001), while the prevalence of T1 primary tumor, N0 lymph node metastasis, and stage I was lower (P = 0.0125, P = 0.0004, P < 0.0001). The rates of resected cases and curative operation (R0) were significantly lower in the elderly group (P < 0.0001, P = 0.0021). The mortality from other diseases was 16.3% in elderly patients and 4.4% in control patients (P < 0.0001). The 5-year survival of stage I and stage IV were not significantly different between the two groups (P = 0.1266 and P = 0.2490). The overall survival and disease-specific survival for all patients in the elderly group were significantly lower than those in the control group (P < 0.0001, P = 0.0102). However, disease-specific survival for resected cases was not significantly different between the two groups (P = 0.0725). CONCLUSIONS: In elderly patients, the reason for the poor prognosis is the high rate of advanced stage and the high rate of death from other diseases.     

Surgical treatment for gastric carcinoma in the elderly

BACKGROUND AND OBJECTIVES: The incidence of gastric cancer is increasing in the elderly. The aim of this study is to evaluate the impact of advanced age (> or =80 years) on morbidity, mortality and late outcome after curative surgery for gastric cancer. METHODS: The cases of 30 octogenarians (Group A) with gastric cancer who underwent surgical treatment in our Institution from 1990 to 2003 were reviewed and compared to a simultaneous group of 228 younger patients (Group B). RESULTS: The rate of resective and curative procedures was not different in the two groups, although the American Society of Anaesthesiologists (ASA) risk was significantly higher in the elderly (P < 0.001) and the lymphatic dissection was less extended in group A. In the two groups, the curability was directly correlated to the cancer stage, but not affected by the ASA risk. The postoperative morbidity and mortality rates were similar in the two groups and were not related to the ASA risk. Considering the mortality for gastric cancer alone, the two groups showed a similar survival rate, only correlated to the cancer stage. CONCLUSIONS: In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory immediate and late results.     

TP/PD-ECGF表达与血小板增多在胃癌中的意义

目的:研究血小板衍化内皮细胞生长因子(TP/PD-ECGF)在胃癌中的表达及血小板增多情况,并对其与胃癌患者临床病理特征和预后的关系进行探讨。方法:采用免疫组化EnVision两步法检测107例胃癌组织中TP/PD-ECGF的表达,记录血小板增多情况,并分析二者与胃癌患者临床病理特征及预后的关系。结果:胃癌患者中TP/PD-ECGF阳性表达率为71.0%,与血小板增多呈正相关(P<0.01)。TP/PD-ECGF表达、血小板增多与肿瘤分期、淋巴结转移、远处转移及分化程度呈正相关。TP/PD-ECGF阳性与阴性表达患者3年、5年总生存率分别为69.04%、18.12%和88.87%、75.20%,二者差异有统计学意义(P=0.0383);3年、5年无进展生存率分别为64.87%、17.92%和82.73%、35.00%,二者差异有统计学意义(P=0.0350)。Cox比例风险模型多因素分析显示,肿瘤分期、淋巴结转移、远处转移、TP/PD-ECGF及血小板增多均是影响胃癌预后独立的危险因素。结论:TP/PD-ECGF表达与血小板增多呈正相关,二者与胃癌生长和浸润转移关系密切,可作为胃癌独立的预后因素。     

Palliative total gastrectomy and esophagogastrectomy. A reevaluation

In the interval from 1941-1981 when 1887 patients with gastric cancer were seen at The University of Texas System Cancer Center M.D. Anderson Hospital and Tumor Institute, 151 curative and 45 palliative total gastrectomies or esophagogastrectomies were performed. Over the same interval, 21 patients with extent of primary and metastatic tumor roughly comparable to that seen in the palliative resection group were treated by exploration only or, infrequently, by attempted bypass. In individual patients subtle differences in extent of disease as well as differences in philosophy of the operating surgeon regarding the value of palliative resection undoubtedly contributed to the procedure selected. Survival after curative resection was greater than after palliative resection which in turn was greater than survival after exploration bypass (P less than or equal to .0006). Operative mortality fell significantly in CR patients in the interval 1970-1981 compared to 1941-1969 and was significantly lower than in the PR group in the interval 1970-1981 (P less than or equal to 0.01). Five-year survival increased significantly (P less than or equal to 0.03) in the CR group when results in the two time intervals were compared but not in other groups.     

胃癌患者组织中miR-497、APC的表达及其与预后的相关性

目的:探究胃癌患者组织中微小RNA-497（miR-497）、腺瘤样息肉蛋白（APC）的表达水平及其与预后的相关性。方法:选取2013年1月至2015年1月本院收治的胃癌患者67例作为研究对象,术中留取患者胃癌组织及癌旁组织。采用实时荧光定量PCR（qRT-PCR）技术检测组织中miR-497、APC mRNA表达水平,采用免疫组织化学染色法检测组织中APC蛋白表达水平,采用Kaplan-Meier法分析不同miR-497、APC表达水平患者生存情况。采用Logistic回归分析胃癌患者预后不良的影响因素。结果:胃癌组织中miR-497、APC mRNA表达水平及APC蛋白高表达率均明显低于癌旁组织（P＜0.05）。与miR-497、APC蛋白高表达患者比较,miR-497、APC蛋白低表达患者中T3-T4浸润深度、TNM分期Ⅲ-Ⅳ期、淋巴结转移比例均明显升高（P＜0.05）;APC蛋白高表达与低表达患者高、中分化与低分化比例比较,差异有统计学意义（P＜0.05）。低分化、T3-T4浸润深度、TNM分期Ⅲ-Ⅳ期、淋巴结转移为胃癌患者预后不良的独立危险因素（P＜0.05）。miR-497、APC蛋白低表达患者5年累积生存率明显低于miR-497、APC蛋白高表达患者（P＜0.05）。胃癌组织中miR-497与APC mRNA表达水平呈正相关（P＜0.05）,但相关性较弱。胃癌组织中miR-497、APC mRNA表达水平对胃癌患者不良预后诊断的曲线下面积分别为0.766、0.816,均明显低于二者联合检测曲线下面积的0.915（P＜0.05）。结论:胃癌组织中miR-497、APC表达水平明显降低,与肿瘤浸润深度加深、分化程度降低、TNM分期升高、淋巴结转移及患者生存率低有关,二者联合对胃癌患者不良预后的诊断价值最高。     

Improved therapeutic index of carboplatin plus cyclophosphamide versus cisplatin plus cyclophosphamide: final report by the Southwest Oncology Group of a phase III randomized trial in stages III and IV ovarian cancer.

PURPOSE: To compare cisplatin-cyclophosphamide versus carboplatin-cyclophosphamide as primary chemotherapy for stage III (suboptimal) and stage IV ovarian cancer. PATIENTS AND METHODS: Three hundred forty-two patients were randomly assigned to treatment with six courses of intravenous (i.v.) cisplatin 100 mg/m2 plus i.v. cyclophosphamide 600 mg/m2, or i.v. carboplatin 300 mg/m2 plus i.v. cyclophosphamide 600 mg/m2. RESULTS: The estimated median survivals were 17.4 and 20.0 months for the cisplatin and carboplatin study arms, respectively. The null hypothesis of a 30% survival superiority with the cisplatin arm was rejected at the P = .02 level. Clinical response rates were 52% for the cisplatin arm and 61% for the carboplatin arm. Pathologic complete response rates were similar for both study arms. There was less thrombocytopenia on the cisplatin arm (P less than .001); however, there was less nausea and emesis (P less than or equal to .001 for courses 1 to 5), renal toxicity (P less than .001), anemia (P = .01), hearing loss (P less than .001), tinnitus (P = .01), neuromuscular toxicities (P = .001), and alopecia (P less than .001) on the carboplatin arm. CONCLUSION: Carboplatin-cyclophosphamide proved to have a significantly better therapeutic index than cisplatin-cyclophosphamide in patients with stage III (suboptimal) and stage IV ovarian cancer.     

进展期胃癌HSP90的表达及其临床意义

目的 探讨热休克蛋白90（HSP90）在进展期胃癌组织中的表达情况,并分析其与胃癌侵袭、转移及预后的关系。方法 采用免疫组化染色法检测157例进展期胃癌组织中HSP90的表达情况,并分析HSP90表达与胃癌临床病理特征及预后的关系。结果 胃癌组织中HSP90高表达率为68.2％（107／157）。HSP90表达与肿瘤大小、肿瘤部位、浸润深度、淋巴结转移及临床分期有关（P＜0.05）,与MMP-9表达呈正相关（r=0.514,P＜0.001）。157例进展期胃癌患者的中位无复发生存时间（RFS）为27.0个月,中位总生存时间（OS）为33.0个月;HSP90低表达患者的中位RFS和OS均为60.5个月,而HSP90高表达者分别为15.0个月和20.0个月（P均＜0.001）。Cox多因素分析显示,HSP90表达为影响胃癌预后的独立因素（P＜0.05）。结论 HSP90表达与进展期胃癌的侵袭转移相关,其高表达提示预后不良。     

Prognosis of T4 gastric carcinoma patients: an appraisal of aggressive surgical treatment

BACKGROUND AND OBJECTIVES: Despite precipitous drop in the incidence of gastric carcinoma in Japan, it is still one of the leading causes of death associated with malignant disease. Once the contiguous organs are involved the prognosis becomes dismal. Prognostic factors governing the survival of patients with T4 gastric carcinoma remain unclear. METHODS: Between 1980 and 1998, 150 patients were treated for T4 gastric carcinoma. Results and prognostic factors were evaluated by univariate and multivariate analyses. RESULTS: With a 73% resectability, patients with tumor resection had a significantly (P < 0.0001) improved survival rate. Within an acceptable operative mortality (2.6%), apparently curative cases had survival benefit (P < 0.0001) over noncurative cases. In the multivariate analysis, the death risk increased by 2.18 (relative risk) when splenectomy was spared from the operative procedure (P < 0.0071). Presence of esophageal invasion was the other independent prognostic factor in T4 gastric carcinoma patients (relative risk 2.11). Conventional prognostic factors along with the type of organs invaded by the carcinoma had no impact on prognosis. CONCLUSIONS: Patients with T4 gastric carcinoma might be benefited from aggressive surgery with a curative intent. Whenever possible, splenectomy should be done along with invaded organ resection.