Ohashi Shinji, Okamura Shozo, Urano Fumihiro, Maeda Matsuyoshi
Center for Preventive Medicine, Toyohashi Municipal Hospital, 50 Aotake-cho, Toyohashi, 441-8085, Japan.
Gastric Cancer. 2007;10(4):241-50. doi: 10.1007/s10120-007-0442-7. Epub 2007 Dec 25.
We aimed to elucidate clinicopathological variables associated with lymph node metastasis of submucosal invasive gastric cancer.
Specimens were surgically resected from 201 patients who had primary submucosal gastric cancer. We studied 39 consecutive patients with lymph node metastasis and 162 patients without lymph node metastasis. We compared the following clinicopathological characteristics of the patients in relation to lymph node metastasis: age, sex, tumor size, histology, extent of submucosal invasion, lymphatic and venous invasion, and ulceration of the tumor. Submucosal invasion was divided subjectively into sm1, sm2, and sm3 (representing invasion of the upper-, middle-, and lower-third of the submucosa, respectively). We also studied the relationship between lymph node metastasis of submucosal gastric cancer and immunohistochemistry for p53, Ki67, vascular endothelial growth factor (VEGF), alpha-fetoprotein, sLe(a), and dendritic cells (DCs).
In terms of conventional pathological factors, lymph node metastasis in submucosal gastric cancer was related to tumor size (P = 0.002), depth of submucosal invasion (P = 0.001), lymphatic invasion (P < 0.0001), and venous invasion (P = 0.012). Lymph node metastasis in sm1 gastric cancer was significantly related to VEGF expression (P = 0.047). Also, lymph node metastasis in sm3 gastric cancer was significantly correlated with DC expression (P = 0.016). Multivariate analysis showed that tumor size, tumor invasion depth in the submucosal layer, and lymphatic invasion were independent predictors of nodal metastasis in submucosal gastric cancer.
Conventional pathological factors, such as tumor size, depth of submucosal invasion, and lymphatic invasion, have a significant influence on lymph node metastasis. VEGF expression and DC expression may be helpful predictors of lymph node metastasis in patients with sm1 and sm3 gastric cancer, respectively.
我们旨在阐明与黏膜下浸润性胃癌淋巴结转移相关的临床病理变量。
从201例原发性胃黏膜下癌患者中手术切除标本。我们研究了39例连续发生淋巴结转移的患者和162例未发生淋巴结转移的患者。我们比较了患者与淋巴结转移相关的以下临床病理特征：年龄、性别、肿瘤大小、组织学、黏膜下浸润范围、淋巴管和静脉侵犯以及肿瘤溃疡情况。黏膜下浸润主观上分为sm1、sm2和sm3（分别代表黏膜层上三分之一、中三分之一和下三分之一的浸润）。我们还研究了胃黏膜下癌淋巴结转移与p53、Ki67、血管内皮生长因子（VEGF）、甲胎蛋白、sLe(a)和树突状细胞（DCs）免疫组化之间的关系。
就传统病理因素而言，胃黏膜下癌的淋巴结转移与肿瘤大小（P = 0.002）、黏膜下浸润深度（P = 0.001）、淋巴管侵犯（P < 0.0001）和静脉侵犯（P = 0.012）有关。sm1期胃癌的淋巴结转移与VEGF表达显著相关（P = 0.047）。此外，sm3期胃癌的淋巴结转移与DC表达显著相关（P = 0.016）。多因素分析表明，肿瘤大小、黏膜下层肿瘤浸润深度和淋巴管侵犯是胃黏膜下癌淋巴结转移的独立预测因素。
传统病理因素，如肿瘤大小、黏膜下浸润深度和淋巴管侵犯，对淋巴结转移有显著影响。VEGF表达和DC表达可能分别是sm1期和sm3期胃癌患者淋巴结转移的有用预测指标。
