Background: Early gastric cancer (EGC) generally has a good prognosis. However, the current definition of EGC includes various subgroups of patients with different pathological characteristics and different prognoses, some of whom have aggressive disease with a biological behavior similar to that of advanced carcinoma.
Materials and methods: We retrospectively evaluated 1,074 patients with EGC who had undergone surgery between 1982 and 2009. The cumulative incidence function of cancer-specific mortality and competing mortality were estimated using the Fine and Gray method.
Results: The median follow-up period was 193 months (range 1-324). Five hundred and sixty-two (52.3%) patients died, 96 (8.9%) from EGC. The 5-, 10-, and 15-year cumulative incidence rates for mortality of all causes were 20.5% (95% confidence interval [CI] 18.0-22.9), 37.1% (95% CI 34.7-40.7), and 52.6% (95% CI 49.1-56.0), respectively; for cancer-specific mortality, 6.0% (95% CI 4.5-7.6), 9.9% (95% CI 7.9-11.9), and 11.1% (95% CI 8.8-13.3), respectively; and for mortality of other causes, 14.4% (95% CI 12.1-16.6), 27.2% (95% CI 24.2-30.2), and 41.5% (95% CI 38.1-43.3), respectively. A significant increase in the risk of cancer-specific mortality was observed for lesions >2 cm (adjusted hazard ratio [HR] = 1.44, 95% CI 1.07-1.94), Pen A-type disease (adjusted HR = 1.73, 95% CI 1.15-2.61), and node-positive cancers (adjusted HR = 2.28, 95% CI 1.61-3.21).
Conclusion: Patients with EGC with tumors >2 cm, Pen A-type disease according to Kodama, or lymph node metastases show a poorer prognosis and an increased risk of cancer-specific mortality.
Implications for practice: Early gastric cancer generally has a good prognosis, and some patients can be treated radically by endoscopic resection. However, the current definition of early gastric cancer includes subgroups of patients with an aggressive disease. In particular, patients with lymph node metastases and Pen A-type tumors according to Kodama's classification need a more invasive treatment, such as subtotal or total gastrectomy with an extended D2 lymphadenectomy, plus eventual adjuvant chemotherapy.
摘要
背景.早期胃癌(EGC)通常具有良好的预后。然而,当前的EGC定义包括具有不同病理特征和不同预后的多个患者亚组,其中一些侵袭性疾病的生物学行为与晚期肿瘤相似。
材料与方法.我们对曾在1982年至2009年之间进行过手术的1 074例EGC患者进行回顾性评价。使用Fine和Gray方法估算癌症特异性死亡率和竞争性死亡率的累积发生率函数。
结果.中位随访期为193个月(范围1‐324)。562例(52.3%)患者死亡,96例(8.9%)死于EGC。全因死亡率的5、10和15年累积发生率分别为20.5%[95% 置信区间(CI)18.0‐22.9]、37.1%(95% CI 34.7‐40.7)和52.6%(95% CI 49.1‐56.0);癌症特异性死亡率,分别为6.0%(95% CI 4.5‐7.6)、9.9%(95% CI 7.9‐11.9)和11.1%(95% CI 8.8‐13.3);其他原因导致的死亡率,分别为14.4%(95% CI 12.1‐16.6)、27.2%(95% CI 24.2‐30.2)和41.5%(95% CI 38.1‐43.3)。在病灶>2cm[校正风险比(HR)=1.44,95% CI 1.07‐1.94]、存在Pen A型疾病(校正HR=1.73,95% CI 1.15‐2.61)和淋巴结阳性(校正HR=2.28,95% CI 1.61‐3.21)的情况下,观察到癌症特异性死亡率的风险显著增加。
结论.肿瘤>2cm、存在Pen A型疾病(根据Kodama)或淋巴结转移的EGC患者显示预后更差且癌症特异性死亡风险增加。
对临床实践的提示:早期胃癌通常具有良好的预后,一些患者可通过内镜切除得到根治。然而,当前的早期胃癌定义包括存在侵袭性疾病的患者亚组。尤其是存在淋巴结转移和Pen A型肿瘤(根据Kodama分类)的患者需要更积极的治疗,如胃大部切除术或全胃切除术和广泛性D2淋巴结切除术,可能联合辅助化疗。
Keywords: Definition; Early gastric cancer; Prognosis; Treatment.
© AlphaMed Press 2018.