Clinicopathology of Early Gastric Cancer

早期胃癌的臨床病理

陳建成(Chien-Cheng Chen) ； 蔡孟叡(Meng-Jui Tsai) ； 羅永男(Yung-Nan Luo) ； 李孟達(Meng-Dar Lee) ； 林光洋(Kuang-Yang Lin)

《北市醫學雜誌》 3卷6期 (2006/06) Pp. 632-641

https://doi.org/10.6200/TCMJ.2006.3.6.11

摘要

目的：早期胃癌對於治癒性切除的預後結果十分令人滿意，早期胃癌的盛行率在日本是高於西方國家的，侷限性的手術是目前對於早期胃癌的治療方法。方法：我們分析254位1974年到2000年之間在本院因診斷早期胃癌而接受胃癌手術的病人，超過95%的病人有接受淋巴腺清除術（包含D1：第一群淋巴腺清除之治癒性切除和D2：第二群淋巴腺清除之治癒性切除），242位病人接受遠端次全胃切除術，7位病人接受近端胃切除術，而5位病人接受全胃切除術。結果：最多的表現症狀為腹痛(45.7%)其次為出血(18.1%)；超過一半的病人(61.8%)腫瘤在胃的下三分之ㄧ；巨觀上來看，大部分的病灶是Ⅱc或是ⅡC+Ⅲ；24位病人有第一群的淋巴腺轉移和7位病人有第二群的淋巴腺轉移；總觀而言，五年的存活率為94.4%，但若是合併第一群或是第二群淋巴腺的轉移，五年存活率則為85.7%和80%。結論：黏膜或是黏膜下病灶對於存活率並沒有影響，對於早期胃癌而言，淋巴腺的轉移與否是最重要的預後因子。

關鍵字

早期胃癌 ； 臨床病理分析

並列摘要

Background and Purpose: The prognosis of early gastric cancer is considered to be satisfactory after a curative resection. The incidence of early gastric cancer is higher in Japan than that in the Western countries. Limited surgery is recommended now for early gastric cancer. Methods: 254 patients of early gastric cancer were retrospectively analyzed who were operated on in the period from 1974 to 2004. Lymph node dissection (D1 or D2) was performed in over 95% of all these patients. 242 patients (95.3%) underwent distal subtotal gastrectomy and 7 patients (2.8%) underwent proximal gastrectomy. 5 patients (2.0%) of larger tumor received total gastrectomy. Results: The most common symptom was abdominal pain (45.7%) followed by bleeding (18.1%) Over half (157 cases; 61.8 %) of the tumors were located in the lower third of the stomach. Macroscopically, most of the lesions were Ⅱc or Ⅱc+Ⅲ(113 lesions: Ⅱc; 86 lesions: Ⅱc+Ⅲ) 24 patients (9.5%) had level 1 lymph node metastasis and metastasis to the level 2 nodes was detected in 7 patients (2.8%). The 5-year survival rate for all the patients with early gastric cancer was 94.4%. The 5-year survival rates for patients of pN1 and pN2 were 85.7% and 80% respectively. Conclusion: There was no survival difference between mucosal and submucosal cancer. Lymph node involvement is the most important prognostic factor for early gastric cancer.

並列關鍵字

early gastric cancer ； surgery ； clinicopathologic analysis