Exploring Individualized Follow-up of Gastric Cancer After Radical Surgery Based on pTNM Stage: A Retrospective Cohort Study From China
Cheng ZhengMengyi QianTongmin HuangXingchen LiuXiangman ZengXiaotong ChenYan ShenPing ChenFeng WuLihu Gu
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Background: Patients with gastric cancer (GC) who underwent radical surgery require long-term follow-up (usually 5 years). The purpose of this study was to explore individualized follow-up strategies for patients with GC. Methods: This is a retrospective cohort study that established a clinicopathologic database of patients who underwent gastrectomy from January 2010 to December 2020 at Ningbo No. 2 Hospital. Follow-up was performed until March 2023. The rate of new-onset recurrence of patients with GC was explored annually according to different pTNM stages, defining a recurrence rate of less than 1% as adequate follow-up time. Results: Of the 1606 patients who were eligible, the total number of patients who completed the 5- and 10-year follow-up was 1107 and 586, respectively. A total of 444 cases were diagnosed with recurrence. The recurrence rate for stage IA patients was consistently less than 1% during the follow-up time. The adequate follow-up time (the rate of new-onset recurrence less than 1%) was 5 years for stage IB and IIA patients, and 8 years for stage IIB and IIIA patients, respectively. In contrast, stage IIIB patients were always at risk of recurrence during the follow-up time (>1%). Time to a new recurrence rate for stage IIIC patients was 6 years. Conclusion: Among patients who underwent radical gastrectomy, the rate of new-onset recurrence varied among patients with different pTNM stages. This study suggests that the follow-up of GC can be individualized and refer to pTNM stage.CTによる膀胱腫瘍浸潤度判定をより客観的なものとする目的で, 新たに理想膀胱外壁線および腫瘍根部径 (W)-縦径 (H) 比を設定して各浸潤度別に比較検討し, 以下の検討結果をえた. (1) CTによる形態診断で, 小乳頭状型, 乳頭状有茎性型, 乳頭状無茎性型を示したものはすべて Stage B1以下であつた. 広基結節型を示した23例中19例は, CTによる判定通り広基結節型 Stage B2以上であつたが, 残りの4例は摘出標本では乳頭状無茎性型 Stage B1であつた. (2) 体位変換時の腫瘍変位性は, 乳頭状有茎性型形態を示したもののみに認められ, そのすべてが Stage B1以下であつた. (3) 理想膀胱外壁線外への腫瘍突出は広基結節型を示した Stage C 以上の全例に認められた. また, 従来膀胱壁外には突出しないとされてきた Stage B2の6例中4例に認められた. 突出した腫瘍根部の外壁を比較すると Stage B2ではその突出部の性状は平滑であつたが, Stage C 以上の場合は不整であつた. (4) W/H比に関しては, 乳頭状型を呈した Stage B1以下と広基結節型を呈した Stage B2以上は1.2で明瞭に判別できた.以上より作成したCTによる膀胱腫瘍浸潤度判定基準により, Stage B1以下では37例中26例 (70%), Stage B2以上では19例中16例 (84%). 特に膀胱内注入物質として空気を用いた場合, Stage B2以上において15例中15例 (100%) と非常に高い一致率が得られた.本判定基準による膀胱腫瘍浸潤度のCT診断は, 従来は極めて困難であつた深層浸潤性腫瘍の各 Stage の判別診断を可能とし, 臨床上極めて有用なものと考える.
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STUDIES on patients who have survived total gastrectomy for three years or more are few, and contradictory results are reported. For this reason and since total gastrectomy is being practiced with rapidly increasing frequency, we have studied intestinal motor function, intestinal absorption, pancreatic function and the blood picture in 3 patients who have survived total gastrectomy for three, five and ten years, respectively.¶Case ReportsCase 1. E. O., a 58-year-old woman, was admitted to the hospital with a history of anorexia, weight loss and vomiting of 3 years' duration. A total gastrectomy with enteroenterostomy was performed on May 28, . . .
Anorexia
Pancreatic function
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Surgical oncology
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Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer.To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy.Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight.Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.
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地方性甲状腺腫は臨床, 病理学的に複雑な経過を示し, 疫学的, 病理学的発生論や治療の選択に多くの難題が残されている. 著者は本症の病期検討および妥当な病期分類がこれらの検索, 解明にきわめて有用であると着目し, 甲状腺剔出を行なった地方性甲状腺腫336例を臨床, 病理学的に精査し下記の結果をえた. 1) 地方性甲状腺腫は臨床的, 病理学的経過からStage 1;過形成期, Stage 2;腫大期, Stage 3;結節形成期と分類できた. 2) 本症は病期の進行に伴い病悩期間は長くなり, 甲状腺腫は増大し種々の局所圧迫症状をみるが, 合併症がなければ全身的, 臨床生化学的所見はほぼ正常である. 3) 臨床, 病理学的に本症はStage 1からStage 2さらにStage 3に進行し, Stage 3は終末期である. 4) 病変の占居部位はStage 1では両葉性, Stage 2では両葉性と単葉性がほぼ等しく, Stage 3では単葉性が多い点からもStageの進行度を裏付けられる. 5) 336例のうち男性39例, 女性297例, 男女比1:7.6で, 発生のピークは女性では20才から30才代, 男性は30才から40才代であった. 6) 手術適応例は若年者より成人に多く, 女性は男性より著しく多い. ヨード治療の効果が若年者ほど良好で, 男性は女性よりもヨード感受性が高いためである. 7) Stage 3の9.4%に甲状腺機能亢進症 (4.03%), 腺腫 (1.34%), 甲状腺癌 (4.03%) などの共存疾患がみられた. 8) ヨード治療はStage 1では効果的であるがStage 2では無効でStage 3に進行し, 種々の合併症を起こすこともあり, Stage 2における手術が望ましい.
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Some aspects of the patient after total gastrectomy : clinical studies on symptomatology, nutrient malasseimilation and medico-social performance after total gastrectomy
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腎細胞癌50例 (stage 1が12例, stage 2が15例, stage 3Aが5例, stage 3Bが2例, stage 3Cが1例, stage 4Aが1例, stage 4Bが14例) の腎動脈撮影時における静脈像所見について検討を行つた.腎動脈撮影で腎静脈本幹が描出されたものは, 50例中21例 (42%) で, 正常腎の腎静脈描出率83% (30例中25例) より低かつた. また患側別では, 右側が28例中9例 (32%), 左側が22例中12例 (55%) であり, 右腎静脈は左腎静脈と比較して描出率が低かつた. 一方, high stage (stage 3およびstage 4)は, low stage (stage 1およびstage 2) に比べて, 腎静脈描出率が低かつたが, high stageのうち腎静脈腫瘍血栓を除けば, 腎静脈描出率は low stage のそれと同程度であつた.腎動静脈瘻は50例中6例 (12%) に認めたが, そのうち腎静脈腫瘍血栓は3例 (50%) と高率に合併していたが, その予後は必ずしも悪くない傾向であつた.腎静脈腫瘍血栓を認めた13例中, 腎動脈撮影で striated vascular pattern は10例 (77%) に描出された.側副静脈は50例中11例 (22%) に認めたが, そのうち腎静脈腫瘍血栓の合併は5例 (45%) で, 残り6例は腎静脈腫瘍血栓が認められないにもかかわらず, 側副静脈が描出されており, 腎静脈腫瘍血栓と側副静脈描出の関連性は少ないと考えられた.
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