• 廣西醫(yī)科大學第一附屬醫(yī)院普外科（南寧530021）;

目的探討提高進展期胃癌臨床治療水平的策略。
方法在Medline上檢索有關文獻并綜述。
結果第5版UICC/AJCC胃癌TNM分期對評估胃癌擴大淋巴結切除術的預后作用有意義。胃癌的分期、淋巴結切除的范圍、程度及輔助性治療方案等都是影響胃癌預后的因素。
結論對胃癌根治術的病例應實施個體化擴大淋巴結切除術和堅持綜合性治療原則。

引用本文： 解乃昌,林進令. 進展期胃癌臨床治療的現狀. 中國普外基礎與臨床雜志, 2006, 13(1): 52-55. doi: 復制

1. Ichikura T, Ogawa T, Chochi K, et al. Minimum number of lymph nodes that should be examined for the International Union Against Cancer/American Joint Committee on Cancer TNM classification of gastric carcinoma [J]. World J Surg, 2003; 27(3)∶330.
2. Kikuchi S, Katada N, Sakuramoto S, et al. Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer [J]. Hepatogastroenterology, 2003; 50(53)∶1723.
3. Nitti D, Marchet A, Olivieri M, et al. Lymphadenectomy in patients with gastric cancer. A critical review [J]. Suppl Tumori, 2003; 2(5)∶S35.
4. Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study [J]. Ann Surg Oncol, 2002; 9(9)∶894.
5. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10)∶1888.
6. Verreet PR. Stageadapted radical principles in gastric carcinoma [J]. Schweiz Rundsch Med Prax, 1998; 87(13)∶447.
7. Roviello F, Marrelli D, Morgagni P, et al. Benefits of extended lymphadenectomy in patients with gastric carcinoma with metastasis to second level lymph nodes. An Italian multicenter study [J]. Chir Ital, 2003; 55(4)∶491.
8. Ikeguchi M, Oka S, Gomyo Y, et al. Prognostic benefit of extended radical lymphadenectomy for patients with gastric cancer [J]. Anticancer Res, 2000; 20(2B)∶1285.
9. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [J]. J Clin Oncol, 2004; 22(11)∶2069.
10. Maruyama K, Sasako M, Kinoshita T, et al. Reasonable lymph node dissection in radical gastrectomy for gastric cancer: introduction of computer information system and lymphography technique by Indiaink [J]. Nippon Geka Gakkai Zasshi, 1989; 90(9)∶1318.
11. Maruyama K, Gunven P, Okabayashi K, et al. Lymph node metastases of gastric cancer. General pattern in 1 931 patients [J]. Ann Surg, 1989; 210(5)∶596.
12. Omejc M, Mekicar J. Role of computer analysis in gastric cancer surgery: evaluation of the WinEstimate v. 2.5 computer program [J]. World J Surg, 2004; 28(1)∶59.
13. Ohta K, Nishi M, Nakajima T, et al. Indications for total gastrectomy combined with pancreaticosplenectomy in the treatment of middle gastric cancer [J]. Nippon Geka Gakkai Zasshi, 1989; 90(9)∶1326.
14. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreatic lymph nodes? [J]. Anticancer Res, 2002; 22(6B)∶3513.
15. Marrelli D, Roviello F, de Manzoni G, et al. Different patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal study [J]. World J Surg, 2002; 26(9)∶1160.
16. Shiraishi N, Inomata M, Osawa N, et al. Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses [J]. Cancer, 2000; 89(2)∶255.
17. Funami Y, Tokumoto N, Miyauchi H, et al. Prognostic value of peritoneal lavage cytology and chemotherapy during surgery for advanced gastric cancer [J]. Int Surg, 1999; 84(3)∶220.
18. Sethna KS, Sugarbaker PH. New prospects for the control of peritoneal surface dissemination of gastric cancer using perioperative intraperitoneal chemotherapy [J]. Cancer Therapy, 2004; 2（A）∶79.
19. Marutsuka T, Shimada S, Shiomori K, et al. Mechanisms of peritoneal metastasis after operation for nonserosainvasive gastric carcinoma: an ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis [J]. Clin Cancer Res, 2003; 9(2)∶678.
20. Yonemura Y, de Aretxabala X, Fujimura T, et al. Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study [J]. Hepatogastroenterology, 2001; 48(42)∶1776.
21. 梁寒， 王仆， 王曉娜， 等. 活性碳吸附絲裂霉素C腹腔化療預防進展期胃癌術后復發(fā) [J]. 中華外科雜志, 2003; 41(4)∶274.
22. Newman E, Marcus SG, Potmesil M, et al. Neoadjuvant chemotherapy with CPT11 and cisplatin downstages locally advanced gastric cancer [J]. J Gastrointest Surg， 2002; 6(2)∶212.
23. Ajani JA, Mansfield PF, Janjan N, et al. Multiinstitutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma [J]. J Clin Oncol， 2004; 22(14)∶2774.
24. Kim JP, Yu HJ, Lee JH. Results of immunochemosurgery for gastric carcinoma [J]. Hepatogastroenterology， 2001; 48(41)∶1227.
25. Nakahara S, Tsunoda T, Baba T, et al. Dendritic cells stimulated with a bacterial product, OK432, efficiently induce cytotoxic T lymphocytes specific to tumor rejection peptide [J]. Cancer Res， 2003; 63(14)∶4112.
26. Kono K, Takahashi A, Ichihara F, et al. Prognostic significance of adoptive immunotherapy with tumorassociated lymphocytes in patients with advanced gastric cancer: a randomized trial [J]. Clin Cancer Res， 2002; 8(6)∶1767.
27. Kono K, Takahashi A, Sugai H, et al. Dendritic cells pulsed with HER2/neuderived peptides can induce specific Tcell responses in patients with gastric cancer [J]. Clin Cancer Res， 2002; 8(11)∶3394.
  1. 1. Ichikura T, Ogawa T, Chochi K, et al. Minimum number of lymph nodes that should be examined for the International Union Against Cancer/American Joint Committee on Cancer TNM classification of gastric carcinoma [J]. World J Surg, 2003; 27(3)∶330.
  2. 2. Kikuchi S, Katada N, Sakuramoto S, et al. Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer [J]. Hepatogastroenterology, 2003; 50(53)∶1723.
  3. 3. Nitti D, Marchet A, Olivieri M, et al. Lymphadenectomy in patients with gastric cancer. A critical review [J]. Suppl Tumori, 2003; 2(5)∶S35.
  4. 4. Roviello F, Marrelli D, Morgagni P, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study [J]. Ann Surg Oncol, 2002; 9(9)∶894.
  5. 5. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10)∶1888.
  6. 6. Verreet PR. Stageadapted radical principles in gastric carcinoma [J]. Schweiz Rundsch Med Prax, 1998; 87(13)∶447.
  7. 7. Roviello F, Marrelli D, Morgagni P, et al. Benefits of extended lymphadenectomy in patients with gastric carcinoma with metastasis to second level lymph nodes. An Italian multicenter study [J]. Chir Ital, 2003; 55(4)∶491.
  8. 8. Ikeguchi M, Oka S, Gomyo Y, et al. Prognostic benefit of extended radical lymphadenectomy for patients with gastric cancer [J]. Anticancer Res, 2000; 20(2B)∶1285.
  9. 9. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [J]. J Clin Oncol, 2004; 22(11)∶2069.
  10. 10. Maruyama K, Sasako M, Kinoshita T, et al. Reasonable lymph node dissection in radical gastrectomy for gastric cancer: introduction of computer information system and lymphography technique by Indiaink [J]. Nippon Geka Gakkai Zasshi, 1989; 90(9)∶1318.
  11. 11. Maruyama K, Gunven P, Okabayashi K, et al. Lymph node metastases of gastric cancer. General pattern in 1 931 patients [J]. Ann Surg, 1989; 210(5)∶596.
  12. 12. Omejc M, Mekicar J. Role of computer analysis in gastric cancer surgery: evaluation of the WinEstimate v. 2.5 computer program [J]. World J Surg, 2004; 28(1)∶59.
  13. 13. Ohta K, Nishi M, Nakajima T, et al. Indications for total gastrectomy combined with pancreaticosplenectomy in the treatment of middle gastric cancer [J]. Nippon Geka Gakkai Zasshi, 1989; 90(9)∶1326.
  14. 14. Kikuchi S, Nemoto Y, Natsuya K, et al. Which patients with advanced, proximal gastric cancer benefit from complete clearance of splenopancreatic lymph nodes? [J]. Anticancer Res, 2002; 22(6B)∶3513.
  15. 15. Marrelli D, Roviello F, de Manzoni G, et al. Different patterns of recurrence in gastric cancer depending on Lauren’s histological type: longitudinal study [J]. World J Surg, 2002; 26(9)∶1160.
  16. 16. Shiraishi N, Inomata M, Osawa N, et al. Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses [J]. Cancer, 2000; 89(2)∶255.
  17. 17. Funami Y, Tokumoto N, Miyauchi H, et al. Prognostic value of peritoneal lavage cytology and chemotherapy during surgery for advanced gastric cancer [J]. Int Surg, 1999; 84(3)∶220.
  18. 18. Sethna KS, Sugarbaker PH. New prospects for the control of peritoneal surface dissemination of gastric cancer using perioperative intraperitoneal chemotherapy [J]. Cancer Therapy, 2004; 2（A）∶79.
  19. 19. Marutsuka T, Shimada S, Shiomori K, et al. Mechanisms of peritoneal metastasis after operation for nonserosainvasive gastric carcinoma: an ultrarapid detection system for intraperitoneal free cancer cells and a prophylactic strategy for peritoneal metastasis [J]. Clin Cancer Res, 2003; 9(2)∶678.
  20. 20. Yonemura Y, de Aretxabala X, Fujimura T, et al. Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study [J]. Hepatogastroenterology, 2001; 48(42)∶1776.
  21. 21. 梁寒， 王仆， 王曉娜， 等. 活性碳吸附絲裂霉素C腹腔化療預防進展期胃癌術后復發(fā) [J]. 中華外科雜志, 2003; 41(4)∶274.
  22. 22. Newman E, Marcus SG, Potmesil M, et al. Neoadjuvant chemotherapy with CPT11 and cisplatin downstages locally advanced gastric cancer [J]. J Gastrointest Surg， 2002; 6(2)∶212.
  23. 23. Ajani JA, Mansfield PF, Janjan N, et al. Multiinstitutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma [J]. J Clin Oncol， 2004; 22(14)∶2774.
  24. 24. Kim JP, Yu HJ, Lee JH. Results of immunochemosurgery for gastric carcinoma [J]. Hepatogastroenterology， 2001; 48(41)∶1227.
  25. 25. Nakahara S, Tsunoda T, Baba T, et al. Dendritic cells stimulated with a bacterial product, OK432, efficiently induce cytotoxic T lymphocytes specific to tumor rejection peptide [J]. Cancer Res， 2003; 63(14)∶4112.
  26. 26. Kono K, Takahashi A, Ichihara F, et al. Prognostic significance of adoptive immunotherapy with tumorassociated lymphocytes in patients with advanced gastric cancer: a randomized trial [J]. Clin Cancer Res， 2002; 8(6)∶1767.
  27. 27. Kono K, Takahashi A, Sugai H, et al. Dendritic cells pulsed with HER2/neuderived peptides can induce specific Tcell responses in patients with gastric cancer [J]. Clin Cancer Res， 2002; 8(11)∶3394.