摘要
目的探讨提高胃癌疗效的方法。方法回顾性分析中山大学肿瘤防治中心外科40年治疗的胃癌共2561例患者的临床资料,并作前后20年患者资料的对比,对影响胃癌疗效的因素采用Cox模型进行多因素分析,用生命表法统计生存率。结果2561例患者中,胃切除1950例,切除率76.1%;其中根治性切除1192例(46.5%),姑息性切除758例(29.6%),其余611例(23.9%)行转流、造瘘或单纯手术探查等手术。手术死亡率为0.8%,并发症发生率为5.1%。本组总的1、3、5年生存率为52.4%、38.6%和35.5%。Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为86.8%、58.7%、28.4%和7.6%。本组胃癌根治术的5年生存率为45.5%,近20年为52.7%,近10年为61.8%。前20年Ⅰ、Ⅱ、Ⅲ、Ⅳ期胃癌的比例分别为1.4%(10/710)、10.6%(75/710)、23.1%(164/710)和64.9%(461/710);后20年分别为9.3%(172/1851)、18.5%(343/1851)和35.3%(654/1851)、36.8%(682/1851)。5年生存率前20年为18.0%,后20年为37.5%。影响本组胃癌预后的主要因素为TNM分期、是否行根治性切除及是否行综合治疗。结论早期诊断是改善胃癌疗效的关键措施,手术切除是治疗胃癌的最有效手段。依据具体病例的肿瘤生物学特性、病期、部位,合理选择手术方案及施行以手术为中心的综合治疗,有助于提高胃癌的生存率。
Objective To investigat the approaches to improve therapeutic effect of stomach cancer by analysis of the long-term results of surgical treatment of this disease. Methods Prognostic factors of stomach cancer were analyzed by Cox multivariate regression model based on clinical data of 2561 stomach cancer cases who underwent surgical treatment from 1964 to 2004 at Sun Yat-sen University Cancer Center. Survival rates were calculated by life table method. Results Gastrectomy was performed for 1950 cases with resectability of 76.1% , among which there were 1192 cases of curative resection （46. 5% ） and 758 cases of non-curative resection （29. 6% ）. The other 611 cases of palliative operation included bypass procedures and laparotomy. Operative mortality of all cases was 0. 8% and morbidity was 5. 1%. For all cases the 1-, 3- and 5-year survival rate was 52.4% , 38.6% and 35.5% , respectively. The stage-specific 5-year survival rate was 86.8% （ Stage Ⅰ ）, 58.7% （ Stage Ⅱ ） , 28.4% （ Stage Ⅲ ） and 7. 6% （ Stage Ⅳ ）, respectively. The 5-year survival after curative resection in the period of 40 years was 45.5% , and increased to 52. 7% in the last two decades and 61.8% in recent decade. Stage-specific case proportion during the earlier two decades was 1.4% （Stage Ⅰ ）, 10.6% （Stage Ⅱ） , 23.1% （Stage Ⅲ） and 64. 9% （Stage Ⅳ）, respectively, and that during the recent two decades was 9.3%, 18.5%, 35.3% and 36.8%, respectively. The 5-year survival rate of cases during the earlier two decades was 18.0% and increased to 37.5% during the recent two decades. Multivariate analysis indicated that main prognostic factors of stomach cancer included TNM staging, curative resection and multidisciplinary treatment. Conclusions Early detection and curative resection were the most important measures to improve therapeutic effect of stomach cancer. A surgery-predominant multidisciplinary treatment individualizing biological characteristics of tumor, staging of disease and tumor site will contribute to improvement of therapeutic effect of stomachcancer.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第17期1109-1113,共5页
Chinese Journal of Surgery
