Nakata Kohei, Nagai Eishi, Miyasaka Yoshihiro, Ohuchida Kenoki, Ohtsuka Takao, Toma Hiroki, Hirahashi Minako, Aishima Shinichi, Oda Yoshinao, Tanaka Masao
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hepatogastroenterology. 2012 Sep;59(118):1855-8. doi: 10.5754/hge10130.
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is gaining wider acceptance for the treatment of early gastric carcinoma (EGC) and its indication has been extended to mucosal gastric carcinoma with undifferentiated component in some institutes. Our aims were to confirm the frequency of lymph node metastasis in such cases and clarify the demarcation in indications for ESD.
We evaluated medical data of 287 patients with mucosal gastric carcinoma who underwent surgical resection between 1996 and 2008. The tumours were histologically classified into purely differentiated (PD), differentiated-predominant mixed (DPM), undifferentiated-predominant mixed (UPM) and purely undifferentiated (PU) types.
Lymph node metastasis was identified in seven (2.4%) of the 287 patients and was detected more frequently in UPM (10%, two of 20) and PU (4%, four of 98), compared with PD (none of 148) (p=0.01 and 0.02, respectively). In mixed-type carcinoma, size was a significant risk factor for lymph node metastasis (p=0.04).
It might be better to select gastrectomy rather than ESD for the treatment of mucosal gastric carcinoma with an undifferentiated component.
背景/目的：内镜黏膜下剥离术（ESD）在早期胃癌（EGC）治疗中的接受度越来越高，在一些机构，其适应证已扩展至伴有未分化成分的黏膜内胃癌。我们的目的是确认此类病例中淋巴结转移的发生率，并明确ESD适应证的界限。
我们评估了1996年至2008年间接受手术切除的287例黏膜内胃癌患者的医疗数据。肿瘤组织学上分为纯分化型（PD）、分化为主的混合型（DPM）、未分化为主的混合型（UPM）和纯未分化型（PU）。
287例患者中有7例（2.4%）发现淋巴结转移，与PD型（148例均无转移）相比，UPM型（20例中有2例，10%）和PU型（98例中有4例，4%）的淋巴结转移更常见（分别为p = 0.01和0.02）。在混合型癌中，肿瘤大小是淋巴结转移的一个显著危险因素（p = 0.04）。
对于伴有未分化成分的黏膜内胃癌，选择胃切除术而非ESD治疗可能更好。
