Kitayama J, Hatano K, Kaisaki S, Suzuki H, Fujii S, Nagawa H
Department of Surgical Oncology, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan 113-8655.
Br J Surg. 2004 Feb;91(2):191-8. doi: 10.1002/bjs.4391.
Although increased dietary fat or cholesterol has been reported to be a risk factor for the development of certain cancers, the effect of serum lipid levels on tumour metastasis is not clearly understood.
The association between lymph node metastasis and preoperative serum levels of total cholesterol (TC) and triglyceride (TG) as well as various pathological findings for tumours was examined in 353 patients with early gastric cancer who underwent gastrectomy with classical lymphadenectomy.
The rate of lymph node metastasis was significantly higher in patients with early gastric cancer who had hypercholesterolaemia (TC 220 mg/dl or greater) or hypertriglyceridaemia (TG 150 mg/dl or greater). The tendency was more prominent in men, and multivariate analysis showed that hypertriglyceridaemia was an independent risk factor for nodal metastasis in men, in addition to pathological invasion to the submucosal layer or to lymphatic vessels. In contrast, neither hypercholesterolaemia nor hypertriglyceridaemia showed a significant association with nodal status in women with early gastric cancer.
Raised serum lipid levels might favour the development of lymph node metastasis in men with early-stage gastric cancer. In patients with early gastric cancer serum lipid levels should be checked before operation, and the use of minimal local treatments must be considered carefully in male patients with hyperlipidaemia.
尽管据报道饮食中脂肪或胆固醇增加是某些癌症发生的危险因素，但血清脂质水平对肿瘤转移的影响尚不清楚。
在353例行胃癌根治术及经典淋巴结清扫术的早期胃癌患者中，研究淋巴结转移与术前血清总胆固醇（TC）、甘油三酯（TG）水平以及肿瘤的各种病理表现之间的关系。
高胆固醇血症（TC≥220mg/dl）或高甘油三酯血症（TG≥150mg/dl）的早期胃癌患者淋巴结转移率显著更高。这种趋势在男性中更为明显，多因素分析显示，除了肿瘤侵犯黏膜下层或淋巴管外，高甘油三酯血症是男性淋巴结转移的独立危险因素。相比之下，高胆固醇血症和高甘油三酯血症与早期胃癌女性患者的淋巴结状态均无显著相关性。
血清脂质水平升高可能有利于早期胃癌男性患者发生淋巴结转移。对于早期胃癌患者，术前应检查血清脂质水平，对于高脂血症男性患者，必须谨慎考虑采用微创局部治疗。
