Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
Chin Med J (Engl). 2012 Mar;125(5):770-4.
Assessment of lymph node metastasis (LNM) is important in early gastric cancer (EGC) and affects treatment decisions. However, the relationship between clinicopathological characteristics and LNM in EGC remains unclear. This study therefore explored favorable predictors of LNM in EGC.
A total of 716 specimens from gastric cancer patients who underwent curative gastrectomy between 1996 and 2003 at Zhejiang Provincial People's Hospital were reviewed. Forty-five cases were EGC, and clinicopathological characteristics such as gender, age, tumor size, location, gross type, differentiation, invasion depth, and vessel involvement were assessed to identify predictive factors for LNM and survival time.
The overall cumulative 5-year survival rate of EGC patients was 88.92%. Among these, 22.4% developed LNM, which was associated with a poor 5-year survival rate of only 72.7%. Patients with tumors larger than 2 cm in diameters, with depth of tumor invasion to the submucosa, and with positive lymphatic or nerve involvement were also inclined to have poorer survival performances. EGC limited to the mucosa but poorly differentiated also had a high risk for LNM. Multivariate analysis identified lymphatic invasion and tumor size as independent prognosis factors related to survival in EGC patients.
Careful planning is required in EGC patients at high risk of lymph node metastases. Endoscopic mucosal resection or endoscopic submucosal dissection and laparoscopic partial gastrectomy should be cautiously used in EGC, and curative gastrectomy including lymphatic dissection and postoperative adjuvant therapy might be considered to improve the prognosis.
淋巴结转移（LNM）的评估在早期胃癌（EGC）中很重要，并且影响治疗决策。然而，EGC 中临床病理特征与 LNM 之间的关系尚不清楚。因此，本研究探讨了 EGC 中 LNM 的有利预测因素。
回顾了 1996 年至 2003 年间在浙江省人民医院接受根治性胃切除术的胃癌患者的 716 例标本。其中 45 例为 EGC，评估了性别、年龄、肿瘤大小、位置、大体类型、分化、浸润深度和血管侵犯等临床病理特征，以确定 LNM 和生存时间的预测因素。
EGC 患者的总 5 年累积生存率为 88.92%。其中，22.4%发生 LNM，其 5 年生存率仅为 72.7%，较差。肿瘤直径大于 2cm、黏膜下浸润深度、淋巴管或神经侵犯阳性的患者也倾向于生存表现较差。局限于黏膜但分化不良的 EGC 也有较高的 LNM 风险。多变量分析确定淋巴管侵犯和肿瘤大小是与 EGC 患者生存相关的独立预后因素。
对于有较高淋巴结转移风险的 EGC 患者需要谨慎规划。内镜黏膜切除术或内镜黏膜下剥离术和腹腔镜部分胃切除术应谨慎用于 EGC，根治性胃切除术包括淋巴结清扫术和术后辅助治疗可能有助于改善预后。
