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頁籤選單縮合
題名 | The Role of Extended Lymphadenectomy and Adjuvant Immunochemotherapy for Gastric Cancer=擴大淋巴廓清及輔助免疫化學治療對胃癌的意義 |
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作者 | 李威傑; 魏達成; 游憲章; 李伯皇; 張金堅; 王世名; 陳楷模; | 書刊名 | 慈濟醫學 |
卷期 | 6:3 1994.09[民83.09] |
頁次 | 頁153-161 |
分類號 | 416.243 |
關鍵詞 | 胃癌; 擴大淋巴廓清; 輔助化學治療; Gastric cancer; Extended lymph node dissection; Adjuvant chemotherapy; |
語文 | 英文(English) |
中文摘要 | 為評估胃癌外科最近的進步,我們針對1978至1987年中接受胃切除術的 482例病例進行回溯性研究,並和1965至1973年中接受治療的264例病人加以比 較。相對於早期的單純性胃切除,在近年來這一階段,根治性胃切除及R2/3淋巴 廓清是標準的外科術式。同時,在近年來的病人中,169(35.1)例病人在術後同時 接受5-fluorouracil,Mitomycin C及PSK(krestin)的長期輔助免疫化學治療。這兩階段 的病人在臨床特性,腫瘤部位,期別或組織分類上並無顯著差異。早期胃癌分別 佔前期病人的11.5及後期的14.7。切除率則由57.8增為68.7,而5年存活率由24.7至 37.9。比較接受單純胃切除及根治胃切除的病人顯示5年存活率可由24.7增為 35.9(p<0.05)。主要受益的病人乃早期及已 |
英文摘要 | To evaluate recent improvements in gastric cancer surgery, we performed a retrospectiveanalysis of data from 482 patients who underwent primary gastrectomies from 1978 to 1987 (therecent group) and 264 patients who had been treated from 1965 to 1973 (the early group). Radical gastric resection with R2/3 lymphadenectomy was the standard procedure in the recent groupas compared to a simple gastrectomy in the early group. In addition, postoperative long-termadjuvant immonochemotherapy with 5-fluorouracil, Mitomycin C, and PSK (Krestin) was given to169 (35.1) patients of the recent group. There were no significant differences in the characteristics of patients and location, stage or histological classification of gastric cancer between thesetwo groups. Early gastric cancers accounted for 11.5 of the patients in the early group and14.7 of the patients in the recent group. The resection rate increased from 57.8 to 686.7 andthe 5-year survival rate increased from 24.7 to 37.9. A comparison of patients with simplegastrectomies and those with radical gastrectomies showed a slight increase in the 5-year survivalrate from 24.7 to 35.9 (p<0.05). The advantage of radical resections was limited to patientsat early stages and those with serosa invasion but without lymph node involvement. Patients whoreceived adjuvant immunochemotherapy after radical gastrectomy had a 5-year survival rate of41.5, an insignificant difference (p>0.05) compared to 35.9 of those who received radicalgastrectomy alone. However, for patients with serosa invasion, combined adjuvant immunochemotherapy after curative resection was associated with an increased survival rate from 37.8 to 63.9(p<0.05). For patients with lymph node involvement, adjuvant immunochemotherapy was alsoassociated with an increased survival rate from 10.4 to 26.4 (p<0.01). In conclusion, thesurvival pf gastric cancer patient after surgery appeared to have improved recently. The advantages of the radical gastrectomy seemed limited for patients at an early stage, especially for thosewithout lymph node involvement. For patients with advanced gastric cancer with serosa and lymphnode involvement, adjuvant immunochemotherapy may be beneficial in addition to extended lymphadenectomy. Further randomized, controlled trials are warranted to clarify these issues. (Tzu-Chi Med J 1994; 6: 153-161) |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。