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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 location and regularity of local or regional tumor recurrence and the value of radiotherapy after radical operation of gastric cancer, and to establish a new method of lymph node classification after radical operation of gastric cancer to guide the determination of target area for radiotherapy. Methods: From March 2006 to February 2010, 43 patients with local or regional recurrence of gastric adenocarcinoma after radical resection were retrospectively analyzed. Radiographic examination confirmed the recurrence of gastric cancer after radical operation. Among them, 10 patients with residual gastric or Anastomotic recurrence of patients by pathological biopsy to be diagnosed. Forty-three patients were analyzed for local or regional recurrence patterns. Results: Among the 43 patients, there were 11 cases (25.6%) with anastomotic or duodenal stump recurrence, 5 cases (11.6%) with recurrent tumor bed, 2 cases with residual stomach recurrence (4.6%) and 35 cases with regional lymph node metastasis 81.4%). The median time to recurrence was 15 months after radical gastrectomy. Median survival after radiotherapy was 15 months, with a 1-year survival rate of 59% and a 2-year survival rate of 31%. The higher the N stage, the shorter the postoperative recurrence. The median tumor response time was 14 months, and was related to the recurrence site (P = 0.023) and gender (P = 0.038). Through the development of a new regional lymph node metastasis after radical gastrectomy method (including Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ), to guide the radiotherapy target area identification and delineation. Conclusion: Local or regional recurrence of gastric cancer mainly includes anastomotic stoma, duodenal stump, tumor bed, residual stomach and regional lymph nodes. Lymph node metastasis is the main tumor recurrence pattern (mainly occurs in Ⅰ, Ⅲ and Ⅵ area). The new regional lymph node metastasis after radical gastrectomy method can guide the determination of radiotherapy target area, outline the radiotherapy target area should include these areas.