128 Background: Among gastric cancer, schirrhus exhibited the poorest prognosis, and many patients die even after curative resection due to recurrence. Although progress of multidisciplinary treatments of advanced gastric cancer is outstanding, recent clinical outcome is obscure by such intensive treatments. Methods: Among the 5,664 gastric cancer patients who underwent gastrectomy between 1971 and 2013 in the Kitasato University Hospital, 287 of shirrhus gastric cancer were included (5%). We divided the total periods into early (1971-2004) and late period (2005-2013), and compared their prognosis. Multivariate proportional hazard model was applied to the significant univariate prognostic factors (p<0.05), and identified independent prognostic factors (IPFs). Finally we compared the IPFs in terms of periods, and discuss the most appropriate treatments. Results: (1) Five-year survival rate was 13% and 31% in the early and late periods, respectively (p=0.0010). Between the periods, there were significant differences of pT (p=0.013), CY (p<0.0001), and Margin status (p=0.041). (2) Univariate prognostic factors were age (p=0.032), pT (p=0.0009), pN (p<0.0001), P (p=0.0033), CY (p=0.0002), and Margin status (p<0.0001). Multivariate proportional hazard model elucidated IPFs of pN (pN0-2 vs pN3a-X, p<0.0001) and Margin status (positive vs negative, p=0.0003). If the 2 factors were combined, patients with pN0-2 plus margin negative showed much better survival (about 40% of 5-year OS) than otherwise cases (below 10%)(p<0.0001). (3) Comparison of the IPFs between early and late periods, margin positive cases were significantly less infrequent in the late period. This may be aggressive application of neoadjuvant chemotherapy of DCS (Docetaxel/CDDP/S1). Conclusions: Due to recent progress of multidisciplinary treatments of preoperative aggressive chemotherapy and surgery with curative intent for negative margin for schirrhus gastric cancer, its 5-year survival was dramatically improved. pN0-2 patients were promising for reasonable prognosis if negative margin is secured, so intraoperative diagnosis must be urgently developed.
COMBINED MITRAL AND AORTIC VALVE REPLACEMENT: PROGNOSTIC FACTORS AFFECTING EARLY AND INTERMEDIATE OUTCOME
