Department of Surgical Oncology, Affiliated Xing Tai People's Hospital of Hebei Medical University, Xingtai 054001, Hebei Province, China.
World J Gastroenterol. 2012 Nov 28;18(44):6489-93; discussion p. 6492. doi: 10.3748/wjg.v18.i44.6489.
To investigate the predictive factors of lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC), and enlarge the possibility of using laparoscopic wedge resection (LWR).
We retrospectively analyzed 85 patients with poorly differentiated EGC who underwent surgical resection between January 1992 and December 2010. The association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (OR) with 95%CI were calculated. We further examined the relationship between the positive number of the three significant predictive factors and the LNM rate.
In the univariate analysis, tumor size (P = 0.011), depth of invasion (P = 0.007) and lymphatic vessel involvement (P < 0.001) were significantly associated with a higher rate of LNM. In the multivariate model, tumor size (OR = 7.125, 95%CI: 1.251-38.218, P = 0.041), depth of invasion (OR = 16.624, 95%CI: 1.571-82.134, P = 0.036) and lymphatic vessel involvement (OR = 39.112, 95%CI: 1.745-123.671, P = 0.011) were found to be independently risk clinicopathological factors for LNM. Of the 85 patients diagnosed with poorly differentiated EGC, 12 (14.1%) had LNM. The LNM rates were 5.7%, 42.9% and 57.1%, respectively in cases with one, two and three of the risk factors respectively in poorly differentiated EGC. There was no LNM in 29 patients without the three risk clinicopathological factors.
LWR alone may be sufficient treatment for intramucosal poorly differentiated EGC if the tumor is less than or equal to 2.0 cm in size, and when lymphatic vessel involvement is absent at postoperative histological examination.
探讨低分化早期胃癌（EGC）淋巴结转移（LNM）的预测因素，扩大腹腔镜楔形切除术（LWR）的应用可能性。
我们回顾性分析了 1992 年 1 月至 2010 年 12 月间接受手术切除的 85 例低分化 EGC 患者。通过单因素和多因素逻辑回归分析，回顾性分析了临床病理因素与 LNM 存在的相关性。计算了 95%置信区间的优势比（OR）。我们进一步检查了三个显著预测因素阳性数量与 LNM 率之间的关系。
在单因素分析中，肿瘤大小（P = 0.011）、浸润深度（P = 0.007）和淋巴管侵犯（P < 0.001）与 LNM 发生率显著相关。在多因素模型中，肿瘤大小（OR = 7.125，95%CI：1.251-38.218，P = 0.041）、浸润深度（OR = 16.624，95%CI：1.571-82.134，P = 0.036）和淋巴管侵犯（OR = 39.112，95%CI：1.745-123.671，P = 0.011）是 LNM 的独立危险因素。在 85 例诊断为低分化 EGC 的患者中，有 12 例（14.1%）发生 LNM。低分化 EGC 中，分别有 1、2 和 3 个危险因素的 LNM 率分别为 5.7%、42.9%和 57.1%。在 29 例没有三个危险因素的患者中没有发生 LNM。
如果肿瘤直径≤2.0cm，且术后组织学检查无淋巴管侵犯，单独行 LWR 可能足以治疗黏膜内低分化 EGC。
