Kunisaki C, Takahashi M, Nagahori Y, Fukushima T, Makino H, Takagawa R, Kosaka T, Ono H A, Akiyama H, Moriwaki Y, Nakano A
Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
Endoscopy. 2009 Jun;41(6):498-503. doi: 10.1055/s-0029-1214758. Epub 2009 Jun 16.
We retrospectively evaluated the predictive factors for lymph node metastasis in poorly differentiated early gastric cancer (poorly differentiated tubular adenocarcinoma, signet-ring cell carcinoma, mucinous adenocarcinoma) in order to examine the possibility of endoscopic resection for poorly differentiated early gastric cancer.
A total of 573 patients with histologically poorly differentiated type early gastric cancer (269 mucosal and 304 submucosal), who had undergone curative gastrectomy, were enrolled in this study. Risk factors for lymph node metastasis were evaluated by univariate and logistic regression analysis.
Lymph node metastasis was observed in 74 patients (12.9%) (6 with mucosal cancer and 68 with submucosal cancer). By univariate analysis risk factors for lymph node metastasis were lymphovascular invasion (LVI) (presence), depth of invasion (submucosa), and tumor diameter (> 20 mm), ulcer or ulcer scar (presence), and histological type (mucinous adenocarcinoma). By multivariate analysis, risk factors for lymph node metastasis were LVI, depth of invasion, and tumor diameter. In mucosal cancers, the incidence of lymph node metastasis was 0% irrespective of LVI in tumors smaller than 20 mm, and 1.7% in tumors 20 mm or larger without LVI. In submucosal cancers, the incidence of lymph node metastasis was 2.4% in tumors smaller than 20 mm without LVI.
A histologically poorly differentiated type mucosal gastric cancer measuring less than 20 mm and without LVI may be a candidate for endoscopic resection. This result should be confirmed in a larger study with many patients.
我们回顾性评估了低分化早期胃癌（低分化管状腺癌、印戒细胞癌、黏液腺癌）淋巴结转移的预测因素，以探讨低分化早期胃癌内镜下切除的可能性。
本研究纳入了573例接受根治性胃切除术的组织学低分化型早期胃癌患者（269例黏膜癌和304例黏膜下癌）。通过单因素和逻辑回归分析评估淋巴结转移的危险因素。
74例患者（12.9%）出现淋巴结转移（6例黏膜癌患者和68例黏膜下癌患者）。单因素分析显示，淋巴结转移的危险因素为淋巴管侵犯（存在）、浸润深度（黏膜下）、肿瘤直径（>20mm）、溃疡或溃疡瘢痕（存在）以及组织学类型（黏液腺癌）。多因素分析显示，淋巴结转移的危险因素为淋巴管侵犯、浸润深度和肿瘤直径。在黏膜癌中，直径小于20mm且无淋巴管侵犯的肿瘤，无论有无淋巴管侵犯，淋巴结转移发生率均为0%；直径20mm及以上且无淋巴管侵犯的肿瘤，淋巴结转移发生率为1.7%。在黏膜下癌中，直径小于20mm且无淋巴管侵犯的肿瘤，淋巴结转移发生率为2.4%。
组织学低分化型、直径小于20mm且无淋巴管侵犯的黏膜胃癌可能是内镜下切除的候选对象。这一结果应在更多患者参与的更大规模研究中得到证实。
