胃癌根治术后局部或区域性复发部位规律及复发后放疗疗效在确定术后放疗靶区中的意义  

The value of patterns of loco-regional recurrence of gastric cancer after curative resection and efficacy of radiation therapy for cancer recurrence in target definition in postoperative radiotherapy

作　　者：李桂超[1] 章真[1] 马学军[1] 俞晓立[1] 蔡钢[1] 胡伟刚[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科、复旦大学上海医学院肿瘤学系,上海200032

出　　处：《肿瘤》2012年第10期794-799,共6页Tumor

摘　　要：目的:探讨胃癌根治术后肿瘤局部或区域性复发的部位及其规律以及放疗的价值,同时建立新的胃癌根治术后淋巴结分组方法以指导放疗靶区的确定。方法:回顾性分析2006年3月—2010年2月共43例胃腺癌根治术后发生局部或区域性复发的患者,均经影像学检查证实为胃癌根治术后复发,其中10例残胃或吻合口复发患者经病理组织学活检予以确诊。对43例患者的局部或区域性复发部位规律进行分析。结果:43例患者中,吻合口或十二指肠残端复发11例(25.6%),肿瘤床复发5例(11.6%),残胃复发2例(4.6%),区域淋巴结转移35例(81.4%)。中位术后复发时间为胃癌根治术后15个月。放疗后的中位生存时间为15个月,1年生存率为59%,2年生存率为31%。N分期越高,术后复发时间越短。中位肿瘤缓解时间为14个月,且与复发部位(P=0.023)和性别(P=0.038)有关。通过拟定新的胃癌根治术后淋巴结转移区域分区方法(包含Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ和Ⅵ区),指导放疗靶区的确定和勾画。结论:胃癌根治术后局部或区域性复发部位主要包括吻合口、十二指肠残端、肿瘤床、残胃和区域淋巴结,其中淋巴结转移是主要的肿瘤复发方式(主要发生在Ⅰ、Ⅲ和Ⅵ区)。新的胃癌根治术后淋巴结转移区域分区方法能够指导放疗靶区的确定,在勾画放疗靶区时应包括上述区域。Objective： To investigate the patterns of loco-regional recurrence of gastric adenocarcinoma after curative resection and evaluate the efficacy of radiation therapy for cancer recurrence, which may be useful to establish a new classification system of regional lymph nodes of gastric cancer to guide target delineation of postoperative radiotherapy. Methods： The clinical records and follow-up information of forty-three patients with loco-regional recurrence after radical resection of gastric adenocarcinoma between March 2006 and February 2010 were retrospectively analyzed. All of the recurrent lesions were confirmed by radiology, and ten patients with gastric remnant and/or anastomotic recurrence were pathologically diagnosed using biopsy. The patterns of loco-regional recurrence of gastric adenocarcinoma after curative resection in these 43 patients were analyzed. Results： Of 43 patients, 11 （25.6%） patients presented with gastric remnant and/or anastomotic recurrence, 5 （11.6%） patients presented with tumor bed recurrence, 2 （4.6%） patients presented with recurrence in remnant stomach, and 35 （81.4%） patients presented with regional lymph node failure. The median time to recurrence after curative resection was 15 months. The median survival after radiation therapy was 15 months, and 1-year and 2-year survival rates were 59% and 31%, respectively. N stage was correlated with time to recurrence. The remission time after radiation therapy was associated with recurrence pattern （P = 0.023） and gender （P = 0.038）, and the median remission time was 14 months. A new classification system of regional lymph nodes after curative resection of gastric cancer （classified as regionsⅠ,Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ） was established to guide target delineation of postoperative radiotherapy. Conclusion： The major failure regions of gastric cancer after curative resection include anastomotic stoma, duodenal stump, tumor bed, gastric remnant and regional lymph nodes, and the primary lesion of posto

关 键 词：胃肿瘤 肿瘤复发 局部 淋巴照射 放疗靶区设计 分区方法 

分 类 号：R735.2[医药卫生—肿瘤]