Department of Pathology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Korea.
Am J Surg Pathol. 2011 Jan;35(1):84-91. doi: 10.1097/PAS.0b013e3181ff61e2.
Micropapillary carcinoma (MPC) is an aggressive variant of adenocarcinoma, with a high incidence of lymph node (LN) metastasis in several organs, although not yet well described in the stomach. Thus, we compared the clinicopathologic characteristics, including survival data and immunohistochemical profiles of cell adhesion molecules (E-cadherin, β-catenin, IQGAP-1, and CD44v6), of MPCs with those of adenocarcinomas lacking MPC components (non-MPC) in the stomach. We compared 72 MPC cases with 160 non-MPC cases. Most gastric MPCs arose from tubular or papillary adenocarcinomas, and the proportion of MPC components ranged from 5% to 80%. MPCs were characterized by more frequent lymphovascular invasion and LN metastasis (P<0.0001), higher tumor node metastasis (TNM) stage (P=0.019), advanced age (>65 y; P<0.0001), and more frequent CD44v6 and aberrant β-catenin expression (P<0.0001). The overall 5-year survival rates for patients with MPC were significantly worse than those with non-MPC (30% vs. 67%; P=0.002). Furthermore, when it was stratified by TNM stages, the survival rates were distinguished between MPC and non-MPC groups in TNM stages I to II (P=0.0003), but not in TNM stages III to IV. The presence of the MPC component was associated with a significantly worse patient survival by univariate (P=0.0003) and multivariate (P=0.04) analyses in patients with stages I to II gastric carcinoma. In conclusion, recognition of the MPC component in gastric carcinoma is critical, because the MPC component is associated with more frequent LN metastasis and a worse prognosis, especially in stages I to II gastric cancer.
微乳头状癌（MPC）是一种侵袭性的腺癌变体，在多个器官中具有较高的淋巴结（LN）转移发生率，尽管在胃中尚未得到充分描述。因此，我们比较了 MPC 与缺乏 MPC 成分的胃腺癌（非-MPC）的临床病理特征，包括生存数据和细胞黏附分子（E-钙黏蛋白、β-连环蛋白、IQGAP-1 和 CD44v6）的免疫组织化学特征。我们比较了 72 例 MPC 病例和 160 例非-MPC 病例。大多数胃 MPC 源自管状或乳头状腺癌，MPC 成分的比例范围为 5%至 80%。MPC 的特点是更频繁的血管淋巴管侵犯和 LN 转移（P<0.0001）、更高的肿瘤淋巴结转移（TNM）分期（P=0.019）、年龄较大（>65 岁；P<0.0001）以及更频繁的 CD44v6 和异常β-连环蛋白表达（P<0.0001）。MPC 患者的总体 5 年生存率明显低于非-MPC 患者（30%比 67%；P=0.002）。此外，当按 TNM 分期分层时，在 TNM 分期 I 至 II 期，MPC 和非-MPC 组之间的生存率存在差异（P=0.0003），但在 TNM 分期 III 至 IV 期则没有。在 I 至 II 期胃癌患者中，单因素（P=0.0003）和多因素（P=0.04）分析均显示，存在 MPC 成分与患者生存显著相关。总之，在胃癌中识别 MPC 成分至关重要，因为 MPC 成分与更频繁的 LN 转移和更差的预后相关，尤其是在 I 至 II 期胃癌中。
