Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Seo-Gu, Busan, Korea.
Gastrointest Endosc. 2010 Sep;72(3):508-15. doi: 10.1016/j.gie.2010.03.1077. Epub 2010 Jun 15.
Given the increasing use of endoscopic resection as a therapeutic modality for cases of early gastric cancer (EGC), it is very important to define strict criteria for the use of endoscopic mucosal resection and endoscopic submucosal dissection. To date, the criteria are almost entirely based on Japanese literature evaluating the risk of lymph node (LN) metastasis in patients with EGC.
To analyze our own experience with the factors affecting LN metastasis and to reappraise the extended criteria for endoscopic submucosal dissection.
Retrospective, single-center study.
University teaching hospital.
This study involved 478 patients who underwent gastrectomy with LN dissection (n = 270, mucosal [m] EGC; n = 208, submucosal [sm] EGC).
Gastrectomy with LN dissection.
LN metastasis.
Overall, 12.6% (60/478) of patients with EGCs presented with LN metastasis (mEGC, 3.0% [8/270], smEGC, 25.0% [52/208]). Increased size, macroscopic type (elevated), depth of invasion, and lymphovascular invasion were associated with LN metastasis. In 270 cases of mEGC, there was no relationship between clinicopathologic features and LN metastasis. In the smEGC group, size, depth of invasion, and lymphovascular emboli were associated with an increased risk of LN metastasis. Significantly, LN metastasis was noted in EGCs falling within established extended endoscopic submucosal dissection criteria, that is, intestinal-type mucosal cancer of any size without ulcer and no lymphovascular emboli (2/146 [1.4%]) or < or =3 cm with no lymphovascular emboli and irrespective of the presence of ulceration (2/126 [1.6%]) or intestinal-type submucosal cancer (sm1, <500 microm) without lymphovascular invasion and measuring < or =3 cm in size (3/20 [15.0%]).
Retrospective review of a single-center study.
We recommend that more centers survey their experiences of LN metastasis in cases of EGC to refine the criteria for endoscopic submucosal dissection as a therapeutic modality of intestinal-type EGC.
鉴于内镜下切除术作为早期胃癌（EGC）治疗手段的应用日益增多，为内镜黏膜切除术和内镜黏膜下剥离术的应用制定严格的标准非常重要。迄今为止，这些标准几乎完全基于评估 EGC 患者淋巴结（LN）转移风险的日本文献。
分析我们在影响 LN 转移的因素方面的经验，并重新评估内镜黏膜下剥离术的扩展标准。
回顾性、单中心研究。
大学教学医院。
本研究纳入了 478 例接受 LN 清扫胃切除术的患者（n=270，黏膜 [m] EGC；n=208，黏膜下 [sm] EGC）。
LN 清扫胃切除术。
LN 转移。
总体而言，478 例 EGC 患者中有 12.6%（60/478）发生 LN 转移（mEGC，3.0%[8/270]；smEGC，25.0%[52/208]）。肿瘤大小、大体类型（隆起型）、浸润深度和脉管侵犯与 LN 转移相关。在 270 例 mEGC 中，临床病理特征与 LN 转移无相关性。在 smEGC 组中，肿瘤大小、浸润深度和脉管内癌栓与 LN 转移风险增加相关。值得注意的是，在符合扩大内镜黏膜下剥离术标准的 EGC 中，包括任何大小无溃疡的肠型黏膜癌且无脉管内癌栓（2/146[1.4%]）或＜或=3cm 且无脉管内癌栓且无论溃疡是否存在（2/126[1.6%]）或肠型黏膜下癌（sm1，＜500μm）且无脉管侵犯且大小＜或=3cm（3/20[15.0%]）中，观察到 LN 转移。
单中心研究的回顾性研究。
我们建议更多中心调查其在 EGC 中 LN 转移的经验，以完善作为肠型 EGC 治疗手段的内镜黏膜下剥离术的标准。
