在2013年3月28日在線出版的《外科腫瘤學(xué)年鑒》(Annals of Surgical Oncology)雜志上,，發(fā)表了美國(guó)紀(jì)念斯隆凱特琳癌癥中心D. G. Coit博士等人的一項(xiàng)研究結(jié)果，該研究針對(duì)接受根治性切除治療的胃癌患者,，旨在考察陽性手術(shù)切緣與生存率和局部復(fù)發(fā)率間的關(guān)系,。
研究人員通過一個(gè)前瞻性數(shù)據(jù)庫(kù),，對(duì)1985年至2010年間接受根治性切除治療的胃癌患者進(jìn)行了篩選。該研究中的陽性切緣指,，腔管截面存在病變,。研究人員還針對(duì)接受胃切除手術(shù)治療的陰性切緣及陽性切緣患者，對(duì)比了其臨床病理學(xué)特征及預(yù)后情況。
研究人員發(fā)現(xiàn),，在接受根治性切除治療的2384例患者中,，共有108 例患者(4.5 %)為陽性切緣。根據(jù)美國(guó)癌癥聯(lián)合委員會(huì)(AJCC)分期系統(tǒng),，陽性切緣與較高的分期結(jié)果,、T分期結(jié)果、N分期結(jié)果,、較高的陽性淋巴結(jié)中位數(shù)目,、彌漫性Lauren型及較差的腫瘤分化情況有關(guān)。陽性切緣的處理方法包括：觀察(39 %),，放化療(26 %),，化療(20 %)，再次切除(10 %),，放療(4 %)以及其他未知療法(1 %),。針對(duì)整個(gè)隊(duì)列進(jìn)行的多變量分析結(jié)果表明，切緣狀態(tài),、T分期,、N分期、腫瘤級(jí)別,、周圍神經(jīng)浸潤(rùn)為與患者生存率相關(guān)的獨(dú)立預(yù)測(cè)因素,。對(duì)于≤3個(gè)陽性淋巴結(jié)或T1-2期、切緣為陽性患者,，切緣狀態(tài)為患者生存率相關(guān)的獨(dú)立預(yù)測(cè)因素,。16 %的患者出現(xiàn)了局部復(fù)發(fā)。研究人員未能鑒別出與陽性切緣患者局部復(fù)發(fā)相關(guān)的預(yù)測(cè)因素,。
研究人員最終認(rèn)為,，手術(shù)陽性切緣與較晚的AJCC分期及侵犯性腫瘤生物學(xué)特征相關(guān)，也仍是生存率相關(guān)的不良獨(dú)立預(yù)后因素,。此外認(rèn)為,，胃癌陽性切緣的意義僅限于非透壁性病情及/或有限淋巴結(jié)侵犯病情的患者。（生物谷Bioon.com）
DOI: 10.1245/s10434-008-9952-8
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Association of Positive Transection Margins with Gastric Cancer Survival and Local Recurrence.
Bickenbach KA Gonen M Strong V Brennan MF Coit DG
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.
