Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 140-743, South Korea.
World J Gastroenterol. 2012 Sep 7;18(33):4578-84. doi: 10.3748/wjg.v18.i33.4578.
To evaluate clinicopathologic parameters and the clinical significance related lymphovascular invasion (LVI) by immunohistochemical staining (IHCS) in endoscopic submucosal dissection (ESD).
Between May 2005 and May 2010, a total of 348 lesions from 321 patients (mean age 63 ± 10 years, men 74.6%) with early gastric cancer (EGC) who met indication criteria after ESD were analyzed retrospectively. The 348 lesions were divided into the absolute (n = 100, differentiated mucosal cancer without ulcer ≤ 20 mm) and expanded (n = 248) indication groups after ESD. The 248 lesions were divided into four subgroups according to the expanded ESD indication. The presence of LVI was determined by factor VIII-related antigen and D2-40 assessment. We compared LVI IHCS-negative group with LVI IHCS-positive in each group.
LVI by hematoxylin-eosin staining (HES) and IHCS were all negative in the absolute group, while was observed in only the expanded groups. The positive rate of LVI by IHCS was higher than that of LVI by HES (n = 1, 0.4% vs n = 11, 4.4%, P = 0.044). LVI IHCS-positivity was observed when the cancer invaded to the mucosa 3 (M3) or submucosa 1 (SM1) levels, with a predominance of 63.6% in the subgroup that included only SM1 cancer (P < 0.01). In a univariate analysis, M3 or SM1 invasion by the tumor was significantly associated with a higher rate of LVI by IHCS, but no factor was significant in a multivariate analysis. There were no cases of tumor recurrence or metastasis during the median 26 mo follow-up.
EGCs of the absolute group are immunohistochemically stable. The presence of LVI may be carefully examined by IHCS in an ESD expanded indication group with an invasion depth of M3 or greater.
评估内镜黏膜下剥离术（ESD）中通过免疫组织化学染色（IHCS）评估的临床病理参数和与淋巴管浸润（LVI）相关的临床意义。
回顾性分析 2005 年 5 月至 2010 年 5 月期间，321 例符合 ESD 适应证的早期胃癌（EGC）患者的 348 处病变，患者平均年龄为 63±10 岁，其中男性占 74.6%。348 处病变根据 ESD 后是否存在绝对（n=100，分化黏膜癌且无溃疡≤20mm）和扩展（n=248）适应证分为两组。根据扩展 ESD 适应证，将 248 处病变分为四个亚组。通过因子 VIII 相关抗原和 D2-40 评估来确定 LVI 的存在。我们比较了每个组中 LVI IHCS 阴性组和 LVI IHCS 阳性组。
在绝对组中，苏木精-伊红染色（HES）和 IHCS 均未观察到 LVI，而仅在扩展组中观察到 LVI。IHCS 检测到的 LVI 阳性率高于 HES（n=1，0.4% vs n=11，4.4%，P=0.044）。当肿瘤侵犯黏膜 3（M3）或黏膜下 1（SM1）时，IHCS 检测到 LVI 阳性，仅包括 SM1 癌的亚组中 LVI IHCS 阳性率较高（63.6%）（P<0.01）。在单因素分析中，肿瘤的 M3 或 SM1 浸润与 IHCS 检测到的 LVI 阳性率显著相关，但多因素分析中没有显著的因素。在中位 26 个月的随访期间，没有肿瘤复发或转移的病例。
绝对组的 EGCs 在免疫组化上是稳定的。在 M3 或更深的浸润深度的 ESD 扩展适应证组中，LVI 可能需要通过 IHCS 仔细检查。
