Postresection Prognosis of Gastric Cancer Patients: Comparison of Staging Systems

手術切除胃癌病人之預後：比較不同分期系統

李威傑(Wei-Jei Lee) ； 李文宗(Wen-Chung Lee) ； 洪士晉(Shyh-Jinn Houng) ； 黃梧蘭(Moe-Lan Wong) ； 魏達成(Ta-Chen Wei) ； 陳楷模(Kai-Mo Chen)

《慈濟醫學雜誌》 6卷1期 (1994/03) Pp. 7-13

https://doi.org/10.6440/TZUCMJ.199403.0007

摘要

癌症的分期系統對於預後評估及外科治療結果分析相當重要。目前有三種常用的分期系統，包括美國聯合癌症分期協會(AJCCS)，日本胃癌研究會(JRSGC) 及國際聯合癌症協會(UICC)的分期系統。我們針對國立台灣大學附屬醫院由1978至1987年中472例接受胃癌切除手術病人進行回溯性研究。病人的5年整體存活率為35.7%。其中265例(56.1%)屬於絕對治癒性切除，150例 (31.8%)為相對治癒性切除，57例(12.1%)為非治癒性切除；其5年存活率分別為54.4%, 13.7%，及5.3%。分析三種分期系統的存活率顯示所有系統皆有預測存活之效果。但是在AJCCS第三期及JRSGC第一及三期分別有不平均的高數目病人，因此在各期之間有較大的存活率差異。而UICC系統則在各期間皆有平均的病人數目以及逐漸下降之存活率。但是UICC系統的第三期A及第三期B病人手術切除後存活率並無不同。此顯示淋巴腺轉移至第二群(N2)是手術切除胃癌預後之重要指標。針對此種病人，尋找積極的有效輔助性化學療法是急需的。本研究顯示國際聯合癌症協會UICC分期系統在胃癌的分期上較AJCCS及JRSGC為理想。我們認為此系統在台灣應該被廣泛使用以做為多院性聯合研究的基礎。

關鍵字

胃癌 ； 期別 ； 外科 ； 存活

並列摘要

The staging classifications of malignant diseases are important for predicting prognosis as well as for the analysis of surgical results. Three staging systems have been proposed for gastric cancer. To compare the efficacy of these 3 systems, we undertook a retrospective review of 472 patients who underwent gastric cancer resection between 1978 and 1987 at National Taiwan University Hospital. The overall 5-year survival rate in this series was 35.7%. Absolutely curative resection were performed in 265 (56.1%), relatively curative in 150 (31.8%) and noncurative in 57 (12.1%). The 5-year survival rates were 54.4%, 13.7% and 5.3% respectively. The survival curves were analyzed according to the American Joint Committee for Cancer Staging and End Reporting (AJCCS), the Union Internationale Contre le Cancer (UICC), and the Japanese Research Society for the Study of Gastric Cancer (JRSGC) classification. All three systems could predict prognosis. However, disproportionately larger patient number was found in stage III of AJCCS and stage I and III in JRSGC classification. The survival curves of stage II and III of the JRSGC system didn’t differ significantly. On the contrary, patient number distributed evently in each stage of the UICC system with stepwise downward survival rate except that there was no significant difference in survival rates between UICC stages IIIA and IIIB. The prognosis for patients who had gastric cancer beyond UICC stage III was dismal. Aggressive adjuvant therapy should be investigated for these patients following gastric resection. The results of this study demonstrate that the UICC classification is better than the AJCCS and JRSGC classification. We propose that this system should be adopted in multi-institute cooperative study.

並列關鍵字

gastric cancer ； staging system ； surgery ； survival