ASO：阳性切缘为胃癌患者不良预后因素

在2013年3月28日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上，发表了美国纪念斯隆凯特琳癌症中心D. G. Coit博士等人的一项研究结果，该研究针对接受根治性切除治疗的胃癌患者，旨在考察阳性手术切缘与生存率和局部复发率间的关系。
本研究通过一个经前瞻性维护的数据库系统，对1985年至2010年间接受根治性切除治疗的胃癌患者进行了筛选。该研究中的阳性切缘指，腔管截面存在病变。研究人员还针对接受胃切除手术治疗的阴性切缘及阳性切缘患者，对比了其临床病理学特征及预后情况。
研究人员发现，在接受根治性切除治疗的2384例患者中，共有108 例患者(4.5 %)为阳性切缘。根据美国癌症联合委员会(AJCC)分期系统，阳性切缘与较高的分期结果、T分期结果、N分期结果、较高的阳性淋巴结中位数目、弥漫性Lauren型及较差的肿瘤分化情况有关。阳性切缘的处理方法包括：观察(39 %)，放化疗(26 %)，化疗(20 %)，再次切除(10 %)，放疗(4 %)以及其他未知疗法(1 %)。针对整个队列进行的多变量分析结果表明，切缘状态、T分期、N分期、肿瘤级别、周围神经浸润为与患者生存率相关的独立预测因素。对于≤3个阳性淋巴结或T1-2期、切缘为阳性的患者，切缘状态为患者生存率相关的独立预测因素，但对于>3个阳性淋巴结或T3-4期患者，切缘状态并不是患者生存率相关的独立预测因素。16 %的阳性切缘患者出现了局部复发。本研究未能鉴别出与阳性切缘患者局部复发相关的预测因素。
研究人员最终认为，手术阳性切缘与较晚的AJCC分期及侵犯性肿瘤生物学特征相关，也仍是不良生存率相关的独立预后因素。此外认为，胃癌阳性切缘的意义仅限于非透壁性病情及/或有限淋巴结侵犯病情的患者。
与胃癌相关的拓展阅读：

• Ann Oncol：HER-2对于胃癌患者来讲意味什么？
• GE：幽门螺杆菌表观遗传学层面调控胃癌发生
• JAMA：确认了与根除和胃癌有关的细菌的因素
• Genome Biol：新研究识别胃癌发生的4种不同机制
• 上海胃癌发病率较高
• Ann Surg Oncol：体重减轻显著影响晚期胃癌患者S-1辅助化疗依从性
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Association of Positive Transection Margins with Gastric Cancer Survival and Local Recurrence.
PURPOSE
To examine the association between positive resection margins and survival and local recurrence in patients with gastric cancer undergoing resection with curative intent.
METHODS
Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2010 were identified from a prospectively maintained database. Positive margins were defined as disease present at the line of luminal transection. Clinicopathological features and outcome of patients undergoing gastrectomy with negative and positive margins were compared.
RESULTS
Among 2384 patients undergoing curative intent resection, 108 (4.5 %) had positive margins. Positive margins were associated with higher American Joint Committee on Cancer (AJCC) stage, T stage, N stage, median number of positive nodes, diffuse Lauren type, and poorly differentiated tumors. Treatment of positive margins consisted of: observation (39 %), chemoradiotherapy (26 %), chemotherapy (20 %), repeat resection (10 %), radiotherapy (4 %), and unknown (1 %). Multivariate analysis of the entire cohort demonstrated margin status, T stage, N stage, grade, and perineural invasion to be independent predictors of survival. Margin status was an independent predictor of survival in patients with ≤3 positive nodes or T1-2 disease but was not in patients with >3 positive nodes or T3-4 disease. Local recurrence occurred in 16 % of patients with a positive margin. We identified no factors predictive of local recurrence in patients with positive margins.
CONCLUSIONS
Positive resection margin is associated with advanced AJCC stage and aggressive tumor biology but remains an independent predictor of worse survival. The significance of a positive margin in gastric cancer is confined to patients with nontransmural disease and/or limited nodal involvement.