Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
Digestion. 2010;81(1):35-42. doi: 10.1159/000235921. Epub 2009 Dec 22.
Endoscopic resection (endoscopic mucosal resection, EMR, and endoscopic submucosal dissection, ESD) has been accepted worldwide as a less invasive standard treatment for early gastric cancer (EGC). However, the risk of synchronous and metachronous gastric cancer developing in the post-endoscopic resection patient has become a major problem. We investigated the incidence and characteristics of synchronous and metachronous multiple gastric cancers in a retrospective study of patients with EGC after endoscopic resection.
We studied the clinicopathological features of 235 patients with EGC who had undergone endoscopic resection and were periodically followed up using endoscopic examinations (181 with a single lesion, 34 synchronous multiple lesions, and 20 metachronous multiple lesions).
The overall incidence of synchronous and metachronous multiple gastric cancer was 14.5 and 8.5%, respectively, during a follow-up of 12-77 (median 26.5) months. Undifferentiated histology of the primary lesion was related to the occurrence of synchronous gastric cancer (p < 0.001). Undifferentiated histology and upper location of the primary lesion were correlated with the occurrence of metachronous gastric cancer (p = 0.002, 0.001). Most synchronous and metachronous lesions were well to moderately differentiated (82.4 and 80.0%); however, the proportion with undifferentiated histology (including poorly differentiated carcinoma and signet ring cell carcinoma) in synchronous and metachronous gastric cancer was significantly higher than in single gastric cancer (p = 0.008).
Undifferentiated histology of EGC may predict the occurrence of synchronous and metachronous lesions after endoscopic resection.
内镜下切除术（内镜黏膜切除术，EMR 和内镜黏膜下剥离术，ESD）已被全球接受为早期胃癌（EGC）的一种微创标准治疗方法。然而，内镜下切除术后患者发生同步和异时性胃癌的风险已成为一个主要问题。我们通过对内镜下切除术后 EGC 患者的回顾性研究，调查了同步和异时性多发性胃癌的发生率和特征。
我们研究了 235 例接受内镜下切除并定期通过内镜检查随访的 EGC 患者的临床病理特征（181 例单发病变，34 例同步多发病变，20 例异时性多发病变）。
在 12-77 个月（中位 26.5 个月）的随访期间，同步和异时性多发性胃癌的总发生率分别为 14.5%和 8.5%。原发肿瘤的未分化组织学与同步性胃癌的发生有关（p < 0.001）。原发肿瘤的未分化组织学和上部位置与异时性胃癌的发生有关（p = 0.002，0.001）。大多数同步和异时性病变为高-中分化（82.4%和 80.0%）；然而，未分化组织学（包括低分化癌和印戒细胞癌）在同步和异时性胃癌中的比例明显高于单发胃癌（p = 0.008）。
EGC 的未分化组织学可能预测内镜下切除术后同步和异时性病变的发生。
