위암의 근치적 절제술 후 임상병리학적 인자에 따른 복막재발의 예측
Prediction of Peritoneal Recurrence after a Curative Resection for Gastric Cancers Based on Clinicopathologic Factors
조삼제, 이건욱, 최국진, 양한광, 정기욱, 김윤호, 이현국, 김진복,
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조삼제 ( Cho Sam-Je )
서울대학교 의과대학 외과학교실
이건욱 ( Lee Kuhn-Uk )
서울대학교 의과대학 외과학교실
최국진 ( Choi Kook-Jin )
서울대학교 의과대학 외과학교실
양한광 ( Yang Han-Kwang )
서울대학교 의과대학 외과학교실
정기욱 ( Chung Ki-Wook )
서울대학교 의과대학 외과학교실
김윤호 ( Kim Yoon-Ho )
서울대학교 의과대학 외과학교실
이현국 ( Lee Hyeon-Kook )
서울대학교 의과대학 외과학교실
김진복 ( Kim Jin-Pok )
서울백병원 한국위암센터
KMID : 0371320010600040398
Abstract
Purpose: This study was designed to investigate the clinicopathologic factors related to peritoneal recurrence and to predict peritoneal recurrence based on clinicopathologic factors.
Methods: A retrospective analysis of 383 patients with peritoneal recurrence, out of 4184 patients who had undergone curative gastric resection at SNUH from 1986 through 1996 was done.
Results: Of the patients with peritoneal recurrence, 275 (71.8%), 97 (25.3%), and 11 (2.9%) were early (0∼24 months), intermediate (24∼60), and late (more than 60) recurrence, respectively. In multivariate analysis, serosal invasion, lymph node metastasis, size of tumor, Borrmann type, perineural invasion and sex were independent prognostic factors for peritoneal recurrence. After classifying all patients into 16 groups on the basis of 4 factors, serosal invasi
on, lymph node metastasis, Borrmann type, and size, the number and proportion of a patients with peritoneal recurrence was obtained. There was 4.2% peritoneal recurrence in the most favorable group (n=71), which had a Borrmann type 1 or 2 lesion less than 5 cm in maximal diameter with neither serosal invasion nor lymph node metastasis. There was a 25.4% peritoneal recurrence in the most unfavorable group (n=331), which had a Borrmann type 3 or 4 lesion more than 5 cm with serosal invasion and lymph node metastasis.
Conclusion: Our results suggest that patients with a Borrmann 3 or 4 lesion more than 5cm in maximal diameter, with serosal invasion and lymph node metastasis have the highest risk for peritoneal recurrence. These patients could be considered as candidates for a treatment modality such as intraperitoneal chemotherapy or hyperthermic chemotherapy.
키워드
위암;재발;위험인자;임상병리학적 인자
Gastric carcinoma;Recurrence;Risk factor;Clinicopathologic factor
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