Department of Gastroenterological Surgery, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan,
Gastric Cancer. 2013 Oct;16(4):537-42. doi: 10.1007/s10120-012-0228-4. Epub 2013 Jan 13.
Intramural metastasis (IM) in gastric cancer is rare. However, it often occurs with esophageal squamous cell carcinoma and has been reported to have a poor prognosis.
In 4,714 cases of gastric cancer that underwent gastrectomy, the clinicopathological features and postoperative prognoses of 29 cases with IM were evaluated and compared with 2,770 cases of advanced gastric cancer without IM.
Of the 4,714 cases, 29 (0.6 %) were histopathologically diagnosed with gastric cancer with IM. There were significant differences in the number of lymph node metastases, capillary invasion, and stage grouping between cases with IM and advanced gastric cancer without IM. Metastasis size was approximately within 2 cm, and many metastases occurred within 2 cm of the primary lesion. Multiple metastases were observed in 38 % of cases and occurred mainly in the submucosa and muscularis propria. IM was detected preoperatively in 17.2 % of cases and was present equally on both sides of the primary lesion. Nine cases had IM outside the stomach. The median survival time with IM was significantly less than in cases of advanced gastric cancer without IM (p < 0.0001). A subgroup of cases with IM within 1 cm of the primary lesion had a relatively favorable prognosis.
The presence of IM is thought to be one of the most important prognostic factors in gastric cancer. Aggressive resection is recommended to increase long-term survival if curative resection is possible.
胃癌的壁内转移（IM）较为罕见，但它常与食管鳞状细胞癌同时发生，并被报道预后较差。
在 4714 例接受胃切除术的胃癌患者中，评估了 29 例 IM 患者的临床病理特征和术后预后，并与 2770 例无 IM 的晚期胃癌患者进行了比较。
在 4714 例患者中，29 例（0.6%）病理诊断为 IM 胃癌。IM 患者与无 IM 的晚期胃癌患者在淋巴结转移数量、毛细血管侵犯和分期分组方面存在显著差异。转移灶大小约为 2cm 以内，许多转移灶发生在原发灶 2cm 以内。38%的病例存在多处转移，主要发生在黏膜下层和肌层。17.2%的病例术前检测到 IM，且原发灶两侧均存在 IM 者比例相等。9 例存在胃外 IM。IM 患者的中位生存时间明显短于无 IM 的晚期胃癌患者（p<0.0001）。原发灶 1cm 以内存在 IM 的亚组患者预后相对较好。
IM 的存在被认为是胃癌最重要的预后因素之一。如果可以进行根治性切除，建议积极切除以提高长期生存率。
