Division of Gastroenterological & General Surgery, Department of Surgery, School of Medicine, Showa University, Tokyo, Japan.
Ann Surg Oncol. 2010 Jun;17(6):1597-604. doi: 10.1245/s10434-010-0930-6. Epub 2010 Feb 4.
Accurate prediction of the metastatic status of lymph nodes (LNs) is clinically important for selecting treatment strategies in patients with gastric cancer with submucosal invasion (GCSM). In this study, we determined the risk factors for lymph node metastasis (LNM), including micrometastasis, in patients with GCSM.
A total of 5610 LNs dissected from 189 patients with GCSM who had undergone a standard gastrectomy were immunostained with CAM 5.2 monoclonal antibody to detect LN micrometastasis. Clinicopathological risk factors for lymph node metastasis (LNM), including micrometastasis, were determined.
LNM was detected in 216 LNs (107 macroscopic metastases, 72 micrometastases, and 37 isolated tumor cells) in 55 (29.1%) of the 189 patients with GCSM. A multivariate analysis revealed that a tumor size of more than 20 mm, a mixed- or undifferentiated-type histology, a vertical tumor invasion depth in the submucosal layer (VTIDSM) of more than 0.5 mm, and the presence of lymphatic vessel invasion (LVI) were independent risk factors for LNM. The incidences of LNM in patients with 0, 1, 2, 3, and 4 risk factors were 0, 4.5, 11.4, 36.1, and 52.9%, respectively. Among the patients with only 1 or 2 risk factors, all the metastatic lesions were located only in the first tier. On the other hand, LNM in the second tier was also detected in 24.5% of the patients with more than 3 risk factors.
Tumor size, histologic type, VTIDSM, and LVI are important risk factors for predicting the presence and extent of LNM in patients with GCSM.
准确预测淋巴结（LN）的转移状态对于选择黏膜下浸润型胃癌（GCSM）患者的治疗策略具有重要的临床意义。本研究旨在确定 GCSM 患者发生 LN 转移（包括微转移）的危险因素。
对 189 例行标准胃切除术的 GCSM 患者的 5610 枚 LN 进行免疫组化染色，使用 CAM 5.2 单克隆抗体检测 LN 微转移。确定与 LN 转移（包括微转移）相关的临床病理危险因素。
在 189 例 GCSM 患者中，55 例（29.1%）的 216 枚 LN 中检测到转移（107 例为宏观转移，72 例为微转移，37 例为孤立肿瘤细胞）。多因素分析显示，肿瘤直径＞20mm、混合型或未分化型组织学、黏膜下层垂直肿瘤侵犯深度（VTIDSM）＞0.5mm、存在淋巴管浸润（LVI）是 LN 转移的独立危险因素。无危险因素、1 个危险因素、2 个危险因素、3 个危险因素和 4 个危险因素患者的 LN 转移发生率分别为 0%、4.5%、11.4%、36.1%和 52.9%。在仅有 1 或 2 个危险因素的患者中，所有转移灶均局限于第一站。另一方面，在具有 3 个以上危险因素的患者中，也检测到第二站的 LN 转移（24.5%）。
肿瘤大小、组织学类型、VTIDSM 和 LVI 是预测 GCSM 患者 LN 转移存在和程度的重要危险因素。
