Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지

Factors Affecting Prognosis in Early Gastric Cancer

조기위암 환자의 예후에 영향을 주는 인자

  • Han, Ki-Bin (Department of Surgery, College of Medicine, Korea University) ;
  • Jang, You-Jin (Department of Surgery, College of Medicine, Korea University) ;
  • Kim, Jong-Han (Department of Surgery, College of Medicine, Korea University) ;
  • Park, Sung-Soo (Department of Surgery, College of Medicine, Korea University) ;
  • Park, Seong-Heum (Department of Surgery, College of Medicine, Korea University) ;
  • Kim, Seung-Ju (Department of Surgery, College of Medicine, Korea University) ;
  • Mok, Young-Jae (Department of Surgery, College of Medicine, Korea University) ;
  • Kim, Chong-Suk (Department of Surgery, College of Medicine, Korea University)
  • 한기빈 (고려대학교 의과대학 외과학교실) ;
  • 장유진 (고려대학교 의과대학 외과학교실) ;
  • 김종한 (고려대학교 의과대학 외과학교실) ;
  • 박성수 (고려대학교 의과대학 외과학교실) ;
  • 박성흠 (고려대학교 의과대학 외과학교실) ;
  • 김승주 (고려대학교 의과대학 외과학교실) ;
  • 목영재 (고려대학교 의과대학 외과학교실) ;
  • 김종석 (고려대학교 의과대학 외과학교실)
  • Received : 2009.04.21
  • Accepted : 2009.10.20
  • Published : 2009.12.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Treatment strategies for early gastric carcinoma (EGC) should be based on achieving a complete cure, but clear indications for limited surgery have not been established. We investigated surgical outcomes for early gastric cancer to determine the optimal? treatment strategy for EGC. Materials and Methods: Subjects included 881 patients who underwent curative surgery for EGC between 1986 and 2003. Retrospective uni & multi-variate analysis for prognostic factors, factors affecting lymph node metastasis, and risk factors for cancer recurrence were analyzed. Results: In multivariate survival analyses, age, operation method, macroscopic appearance and lymph node stage proved to be independent prognostic factors. Lymph node metastasis, depth of tumor invasion, tumor size, lymphatic and venous invasion were also significant risk factors in multivariate analyses. In multivariate analyses for cancer recurrence, depth of tumor invasion and lymph node metastasis proved to be significant risk factors. Conclusion: Appropriate surgical treatment with lymph node dissection is necessary for EGC patients with risk factors for lymph node metastasis.

목적: 최근 조기위암에서 내시경하 점막절제술, 점막하층 박리술과 복강경 보조 위 절제술이 시행되고 있으나 적응 범위는 논란의 여지가 있다. 이에 조기위암으로 수술을 받은 환자들을 분석하여 내시경 치료나 축소 수술 등의 치료 방침의 기준을 보고자 하였다. 대상 및 방법: 1986년부터 2003년까지 조기위암으로 근치절제술을 받은 881명의 환자들을 후향적으로 분석하였다. 전체 환자군에서 예후 인자를 구하고 림프절 전이 및 재발에 영향을 미치는 인자를 알아보았다. 결과: 881명의 환자 중 59명이 사망하였고 21명이 재발되었다. 예후 인자는 단변량 분석상 수술 방법, 종양의 육안적 소견, 정맥관 침습여부와 림프절 병기가, 다변량 분석상 환자의 연령, 수술 방법, 종양의 육안적 소견 및 림프절 병기가 의미 있는 예후 인자였다. 림프절 전이 양성환자는 음성환자에 비해 단변량 분석상, 종양 침윤 깊이, 종양의 크기, 림프절 절제 정도, 림프관 침습여부와 정맥관 침습여부가, 다변량 분석상, 침윤 깊이, 종양 크기, 림프관 침습여부 및 정맥관 침습여부에서 유의한 차이를 보였다. 재발에 영향을 미친 인자에 대하여 다변량 분석 결과 종양의 침윤 깊이와 림프절 전이 여부가 영향을 미친 독립적인 인자로 나타났다. 결론: 조기위암에서 축소 치료 계획 시에는 림프절 전이 가능성을 고려하여 종양의 침윤 깊이와 크기 및 림프관, 정맥관 침습 여부를 확인하여야 하며, 림프절 전이 의심시에는, 위 절제술 및 광범위 림프절 곽청술을 고려해야 한다.

Keywords

References

  1. Oda I, Saito D, Tada M, Iishi H, Tanabe S, Oyama T, Doi T, Otani Y, Fujisaki J, Ajioka Y, et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006;9:262-270. https://doi.org/10.1007/s10120-006-0389-0
  2. Lo SS, Wu CW, Chen JH, Li AF, Hsieh MC, Shen KH, Lin HJ, Lui WY. Surgical results of early gastric cancer and proposing a treatment strategy. Ann Surg Oncol 2007;14:340-347. https://doi.org/10.1245/s10434-006-9077-x
  3. Moreaux J, Bougaran J. Early gastric cancer. A 25-year surgical experience. Ann Surg 1993;217:347-355. https://doi.org/10.1097/00000658-199304000-00006
  4. Sano T, Hollowood A. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 2006;95:249-255. https://doi.org/10.1177/145749690609500407
  5. Roukos DH. Current status and future perspectives in gastric cancer management. Cancer Treat Rev 2000;26:243-255. https://doi.org/10.1053/ctrv.2000.0164
  6. Haruta H, Hosoya Y, Sakuma K, Shibusawa H, Satoh K, Yamamoto H, Tanaka A, Niki T, Sugano K, Yasuda Y. Clinicopathological study of lymph-node metastasis in 1,389 patients with early gastric cancer: assessment of indications for endoscopic resection. J Dig Dis 2008;9:213-218. https://doi.org/10.1111/j.1751-2980.2008.00349.x
  7. Shiraishi N, Yasuda K, Kitano S. Laparoscopic gastrectomy with lymph node dissection for gastric cancer. Gastric Cancer 2006;9:167-176. https://doi.org/10.1007/s10120-006-0380-9
  8. Wu B, Wu D, Wang M, Wang G. Recurrence in patients following curative resection of early gastric carcinoma. J Surg Oncol 2008;98:411-414. https://doi.org/10.1002/jso.21133
  9. Kim DY, Joo JK, Ryu SY, Kim YJ, Kim SK. Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma. World J Gastroenterol 2004;10:737-740. https://doi.org/10.3748/wjg.v10.i5.737
  10. Skoropad V, Berdov B, Zagrebin V. Clinicopathological features and outcome of surgical treatment of 149 patients with early (pT1) gastric cancer. Onkologie 2005;28:247-252. https://doi.org/10.1159/000084303
  11. Shimada S, Yagi Y, Shiomori K, Honmyo U, Hayashi N, Matsuo A, Marutsuka T, Ogawa M. Characterization of early gastric cancer and proposal of the optimal therapeutic strategy. Surgery 2001;129:714-719. https://doi.org/10.1067/msy.2001.114217
  12. Wu CW, Lo SS, Shen KH, Hsieh MC, Lui WY, P'eng FK. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 2000;24:465-472. https://doi.org/10.1007/s002689910074
  13. Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, Sasako M, Sano T, Ochiai A, Yoshida S. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer 1996;77:602-606. https://doi.org/10.1002/(SICI)1097-0142(19960215)77:4<602::AID-CNCR3>3.0.CO;2-I
  14. Maehara Y, Orita H, Okuyama T, Moriguchi S, Tsujitani S, Korenaga D, Sugimachi K. Predictors of lymph node metastasis in early gastric cancer. Br J Surg 1992;79:245-247. https://doi.org/10.1002/bjs.1800790320
  15. Tsujitani S, Oka S, Saito H, Kondo A, Ikeguchi M, Meata M, Kaibara N. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery 1999;125:148-154. https://doi.org/10.1016/S0039-6060(99)70258-8
  16. Talamonti MS, Kim SP, Yao KA, Wayne JD, Feinglass J, Bennett CL, Rao S. Surgical outcomes of patients with gastric carcinoma: the importance of primary tumor location and microvessel invasion. Surgery 2003;134:720-727. https://doi.org/10.1016/S0039-6060(03)00337-4
  17. Abe N, Watanabe T, Suzuki K, Machida H, Toda H, Nakaya Y, Masaki T, Mori T, Sugiyama M, Atomi Y. Risk factors predictive of lymph node metastasis in depressed early gastric cancer. Am J Surg 2002;183:168-172. https://doi.org/10.1016/S0002-9610(01)00860-1
  18. Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 1992;79:241-244. https://doi.org/10.1002/bjs.1800790319
  19. Saka M, Katai H, Fukagawa T, Nijjar R, Sano T. Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer 2008;11:214-218. https://doi.org/10.1007/s10120-008-0485-4
  20. Dicken BJ, Graham K, Hamilton SM, Andrews S, Lai R, Listgarten J, Jhangri GS, Saunders LD, Damaraju S, Cass C. Lymphovascular invasion is associated with poor survival in gastric cancer an application of gene-expression and tissue array techniques. Ann Surg 2006;243:64-73. https://doi.org/10.1097/01.sla.0000194087.96582.3e
  21. Pisanu A, Montisci A, Piu S, Uccheddu A. Curative surgery for gastric cancer in the elderly: treatment decisions, surgical morbidity, mortality, prognosis and quality of life. Tumori 2007;93:478-484. https://doi.org/10.1177/030089160709300512
  22. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, Ponzano C. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005;241:232-237. https://doi.org/10.1097/01.sla.0000151892.35922.f2
  23. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 2005;19:1172-1176. https://doi.org/10.1007/s00464-004-8207-4
  24. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts EJ, Falk SJ, Iveson TJ, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20. https://doi.org/10.1056/NEJMoa055531
  25. Uedo N, Iishi H, Tatsuta M, Ishihara R, Higashino K, Takeuchi Y, Imanaka K, Yamada T, Yamamoto S, Yamamoto S, et al. Longterm outcomes after endoscopic mucosal resection for early gastric cancer. Gastric Cancer 2006;9:88-92. https://doi.org/10.1007/s10120-005-0357-0