目的：探讨胃体癌切除范围对预后的影响。 方法：回顾性分析2003 年4 月―2008 年4 月157 例行胃体癌根治性手术患者的临床资料和随访资料， 其中行全胃切除术的患者104 例（全胃组），行远端胃次全切除术53 例（远端胃组），对比两组的5 年 生存率，分析胃体癌预后的独立影响因素。 结果：全组患者5 年生存率为37.6%，其中全胃组、远端胃组5 年生存率分别为24.0%、64.2%，全胃 组明显低于远端胃组（χ2=10.635，P=0.001）；为消除两组术前基线资料的差异，将TNM 分期分层 对比的结果显示，低TNM 分期患者中，远端胃组生存率明显高于全胃组（P<0.05），而高TNM 分 期患者中，两组生存率差异无统计学意义（P>0.05）。COX 回归模型分析结果显示，TNM 分期（HR=1.270， 95% CI=1.093~2.344）、肿瘤分化程度（HR=1.764，95% CI=1.372~2.746）是胃体癌预后的独立影响 因素（均P<0.05）， 而切除范围（HR=0.547，95% CI=0.320~1.076）不是胃体癌预后的独立影响因 素（P>0.05）。 结论：手术切除范围并非胃体癌预后的独立影响因素，在保证根治性的前提下远端胃次全切除术是更 为适宜的术式。
Clinical analysis in effect of scope of resection on prognosis of cancer in gastric body
Objective: To investigate the influence of resection scope on the prognosis of cancer in the gastric body. Methods: The clinical and follow-up data of 157 patients with cancer in the gastric body undergoing radical surgery from April 2003 to April 2008 were retrospectively analyzed. Of the patients, 104 cases were subjected to total gastrectomy (total gastrectomy group), and 53 cases received distal subtotal gastrectomy (distal gastrectomy group). The 5-year survival rate of the two groups was compared, and the independent prognostic factors for cancer in the gastric body were analyzed. Results: The 5-year survival rate in the entire group of patients was 37.6%, which in total gastrectomy group and distal gastrectomy group was 24.0% and 64.2% respectively, and the former was significantly lower than the latter (χ2=10.635, P=0.001); to balance the difference in preoperative baseline characteristics between the two groups, comparison after stratification by TNM stage showed that the survival rate in distal gastrectomy group was higher than that in total gastrectomy among patients with low TNM stage (P<0.05), but had no significant difference between the two groups among patients with high TNM stage (P>0.05). The results of the Cox regression model analysis identified that the TNM stage (HR=1.270, 95% CI=1.093–2.344) , degree of tumor differentiation (HR=1.764, 95% CI=1.372–2.746)were independent prognostic factors for cancer in the gastric body (both P<0.05), while scope of resection (HR=0.547, 95% CI=0.320–1.076) was not an independent prognostic factor (P>0.05). Conclusion: The scope of resection is not the independent influential factor in the prognosis of cancer of the gastric body, and distal subtotal gastrectomy is a more appropriate procedure to use based on the premise of ensuring a radical resection.