目的: 探讨残胃癌发生位置与其临床病理特征及预后的关系。方法: 回顾性分析2007年1月至2016年12月于我院接受诊治的147例残胃癌病人,吻合口组（90例）和非吻合口组（57例）。比较两组病人的临床病理特征及预后。结果: 与非吻合口组相比,吻合口组的手术间隔时间较长[（245.29±189.53）个月比（157.66±149.11）个月,P=0.004]。初次手术行远端胃切除病人中,吻合口组毕Ⅱ式重建比例较高（71.4%比 42.9%,P=0.001）。吻合口组根治性手术的比例较低（67.8%比84.2%,P=0.027）。吻合口组病人远处转移比例较高（31.1%比12.3%,P=0.009）。吻合口组与非吻合口组的3年生存率分别为30.0%和55.6%（P=0.006）,5年生存率分别为4.4%和28.1%（P<0.001）。吻合口组的预后较差。Kaplan-Meier曲线显示,吻合口组的生存时间明显短于非吻合口组（P=0.007）。结论: 与非吻合口区域的残胃癌相比,吻合口区域的残胃癌TNM分期较晚、远处转移较多、根治性切除率较低、预后较差。
Objective To investigate the location of gastric remnant cancer associated with clinicopathological features and prognosis of the patients with gastric remnant cancer. Methods Retrospective analysis was performed for 147 patients with gastric remnant cancer dividing into anastomotic group (90 cases) and non anastomotic group (57 cases) based on tumor in anastomotic area or not, who admitted to Ruijin Hospital Shanghai Jiao Tong University School of Medicine from January 2007 to December 2016. Clinicopathological characteristics and prognosis were compared between two groups. Results The patients in anastomotic group had longer interval from initial partial gastrectomy than that of patients in non anastomotic group [(245.29±189.53) months vs (157.66±149.11) months, P=0.004]. Patients in anastomotic group were associated with higher reconstruction of Billroth Ⅱ (71.4% vs 42.9%, P=0.001), higher distant metastasis (31.1% vs 12.3%, P=0.009) and lower rate of radical surgery (67.8% vs 84.2%, P=0.027) compared with patients in non anastomotic group. Three year survival rates was 30.0% and 55.6% for anastomotic group and non anastomotic group (P=0.006) and 5 year survival rate 4.4% and 28.1% respectively (P<0.001). It was shown by Kaplan-Meier curve that survival duration was significantly shorter in anastomotic group than in non anastomotic group (P=0.007). Conclusions Gastric remnant cancer located at anastomotic area was in later TNM staging, more distant metastasis, lower rate of radical resection and poorer prognosis compared with those at non anastomotic area.
[1] Shimada H, Fukagawa T, Haga Y, et al.Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association[J]. Gastric Cancer,2016,19(2):339-349.
[2] Ohasi M, Katai H, Fukagawa T, et al.Cancer of the gastric stump following distal gastrectomy for cancer[J]. Br J Surg,2007,94(1):92-95.
[3] Tanigawa N, Nomura E, Lee SW, et al.Current state of gastric stump carcinoma in Japan: based on the results of a nationwide survey[J]. World J Surg,2010,34(7):1540-1547.
[4] Ahn HS, Kim JW, Yoo MW, et al.Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy[J]. Ann Surg Oncol,2008,15(6):1632-1639.
[5] Sinning C, Schaefer N, Standop J, et al.Gastric stump carcinoma-epidemiology and current concepts in pathogenesis and treatment[J]. Eur J Surg Oncol,2007,33(2):133-139.
[6] Nozaki I, Nasu J, Kubo Y, et al.Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery[J]. World J Surg,2010,34(7):1548-1554.
[7] Park JH, Lee JH, Rhee PL, et al.Endoscopic screening for remnant gastric cancer: points to be considered[J]. Gut Liver,2007,1(1):22-26.
[8] Newman E, Brennan MF, Hochwald SN, et al.Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity?[J]. Am J Surg,1997,173(4):292-297.
[9] Tran TB, Hatzaras I, Worhunsky DJ, et al.Gastric remnant cancer: A distinct entity or simply another proximal gastric cancer?[J]. J Surg Oncol,2015,112(8):877-882.
[10] Irino T, Hiki N, Ohashi M, et al.Characteristics of gastric stump cancer: A single hospital retrospective analysis of 262 patients[J]. Surgery,2016,159(6):1539-1547.
[11] Huang H, Wang W, Chen Z, et al.Prognostic factors and survival in patients with gastric stump cancer[J]. World J Gastroenterol,2015,21(6):1865-1871.
[12] 郗洪庆, 崔建新, 胡翀, 等. 残胃癌外科治疗回顾性临床研究[J]. 中华外科杂志,2016,54(3):182-186.
[13] Ohashi M, Morita S, Fukagawa T, et al.Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer[J]. J Surg Oncol,2015,111(2):208-212.
[14] Di Leo A, Pedrazzani C, Bencivenga M, et al.Gastric stump cancer after distal gastrectomy for benign disease: clinicopathological features and surgical outcomes[J]. Ann Surg Oncol,2014,21(8):2594-2600.
[15] Namikawa T, Kitagawa H, Iwabu J, et al.Tumors arising at previous anastomotic site may have poor prognosis in patients with gastric stump cancer following gastrectomy[J]. J Gastrointest Surg,2010,14(12):1923-1930.
[16] An JY, Youn HG, Ha TK, et al.Clinical significance of tumor location in remnant gastric cancers developed after partial gastrectomy for primary gastric cancer[J]. J Gastrointest Surg,2008,12(4):689-694.
[17] Firat O, Guler A, Sozbilen M, et al.Gastric remnant cancer: an old problem with novel concerns[J]. Langenbecks Arch Surg,2009,394(1):93-97.
[18] Kondo K.Duodenogastric reflux and gastric stump carcinoma[J]. Gastric Cancer,2002,5(1):16-22.
[19] Busby WF, Shuker DE, Charnley G, et al.Carcinogenicity in rats of the nitrosated bile acid conjugates N-nitrosoglycocholic acid and N-nitrosotaurocholic acid[J]. Cancer Res,1985,45(3):1367-1371.
[20] Lorusso D, Linsalata M, Pezzolla F, et al.Duodenogastric reflux and gastric mucosal polyamines in the non-opera-ted stomach and in the gastric remnant after Billroth Ⅱgastric resection. A role in gastric carcinogenesis?[J]. Anticancer Res,2000,20(3B):2197-2201.
[21] Kondo K, Suzuki H, Nagayo T.The influence of gastro-jejunal anastomosis on gastric carcinogenesis in rats[J]. Gan,1984,75(4):362-369.
[22] Poon RT, Fan ST, Wong J.Clinical implications of circulating angiogenic factors in cancer patients[J]. J Clin Oncol,2001,19(4):1207-1225.
[23] Carmeliet P.Angiogenesis in life, disease and medicine[J]. Nature,2005,438(7070):932-936.
[24] Carmeliet P.VEGF as a key mediator of angiogenesis in cancer[J]. Oncology,2005,69:4-10.
[25] Bohle B, Pera M, Pascual M, et al.Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice[J]. Surgery,2010,147(1):120-126.
[26] Sasako M, Maruyama K, Kinoshita T, et al.Surgical treatment of carcinoma of the gastric stump[J]. Br J Surg,1991,78(7):822-824.
[27] Kwon IG, Cho I, Choi YY, et al.Risk factors for complications during surgical treatment of remnant gastric cancer[J]. Gastric Cancer,2015,18(2):390-396.
[28] Han SL, Hua YW, Wang CH, et al.Metastatic pattern of lymph node and surgery for gastric stump cancer[J]. J Surg Oncol,2003,82(4):241-246.
