胃近端和远端癌的预后比较及其原因分析

目的探讨胃近端、远端癌的临床和预后的差异及其原因。方法将我院1994年6月至2001年6月经手术治疗的365例胃癌患者的临床、病理及定期随访资料输入数据库,对其一般临床资料、预后因素及生存率进行分析。结果胃近端、远端癌的发病年龄差异无显著性意义(P=0.052),但胃近端癌男性发病的比例较高。标本大体分型中,两组Borrmann分型差异无显著性意义(P=0.6),但胃近端癌的TNM分期较晚,特别是淋巴结转移率明显高于胃远端癌,组织分化类型则无明显差别。虽然胃近端癌全胃切除率较高,但手术并发症发生率和死亡率并无明显增高。胃近端癌手术后的生存率较胃远端癌低。结论胃近端癌预后较胃远端癌差,其重要原因可能与肿瘤的位置特殊、出现症状较晚及就诊时肿瘤分期较晚有关,而与手术并发症发生率和手术死亡率无明确的关系。

Prognostic comparison between proximal and distal gastric cancer and analysis of its causes

Objective To investigate the difference between proximal and distal gastric cancer (PGC, DGC)in clinical findings and prognosis and analyze its causes.Methods Clinical findings, pathology and periodical follow up data of 365 patients undergoing operation for gastric cancer from June 1994 to June 2001 were inputted into the database and were analyzed in clinical data ,prognostic factors and survival rate. Results There was male predominance in PGC group and no difference in the age between two groups. The incidence of more advanced TNM stages and lymph node metastasis in PGC group were significantly higher than that in DGC group (P< 0 05).There were no significant differences in the incidence of Borrmann types and tumor differentiation. The rate of total gastrectomy was higher in PGC group than that in DCG group, but this did not increase surgical morbidity and mortality. The 5 year survival rate in PGC group was lower than that in DGC group(28.4%vs 48.0%, P< 0.01).Conclusions The prognosis of PGC is worse than DGC,and the main causes may be later presentation of symptoms and more advanced TNM stages because of special tumor location in PGC group .The poorer prognosis is not correlated with surgical morbidity and mortality.