Yamada Takeshi, Sugiyama Hiroaki, Ochi Daisuke, Akutsu Daisuke, Suzuki Hideo, Narasaka Toshiaki, Moriwaki Toshikazu, Endo Shinji, Kaneko Tsuyoshi, Satomi Kaishi, Ikezawa Kazuto, Mizokami Yuji, Hyodo Ichinosuke
Division of Gastroenterology, University of Tsukuba Hospital, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan,
Gastric Cancer. 2014 Oct;17(4):692-6. doi: 10.1007/s10120-013-0323-1. Epub 2013 Dec 10.
Submucosal and lymphovascular (SM/LV) invasions of early gastric cancer (EGC) are difficult to diagnose accurately prior to endoscopic submucosal dissection (ESD), and are occasionally found in resected specimens, requiring additional gastrectomy and lymph node dissection. We performed a retrospective study to determine the risk factors for SM/LV invasions.
We analyzed clinicopathological data (age, sex, cancer location, gross morphology, multifocality, tumor size, histological differentiation, depth of invasion, and the presence or absence of lymphovascular invasion) in patients receiving ESD between 2007 and 2012 and presenting with EGC of 2.0 cm or smaller in size, a differentiated-type adenocarcinoma, and without ulceration.
Of 208 lesions consecutively resected by ESD, 143 lesions in 132 patients were included in this study. Submucosal and lymphovascular invasions were detected in 16 lesions. Multivariate analysis revealed three independent risk factors for SM/LV invasions: dominant histology of moderately-differentiated or papillary adenocarcinoma, gross type of 0-IIa + IIc or IIc + IIa, and tumor size of ≥1.5 cm. Lesions exhibiting more than two of these three risk factors were associated with having a 47 % increased incidence of SM/LV invasion (odds ratio 15; 95 % confidence interval 4.6-49.0; P < 0.0001).
Moderately-differentiated or papillary adenocarcinoma, 0-IIa + IIc or IIc + IIa, and a tumor size of ≥1.5 cm were identified as independent risk factors for SM/LV invasion among EGCs which appeared to be an endoscopically good indication for ESD. Careful surveillances including endoscopic ultrasonography or enhanced computed tomography might be needed for high risk patients before ESD.
早期胃癌（EGC）的黏膜下层和淋巴管浸润在进行内镜黏膜下剥离术（ESD）之前很难准确诊断，偶尔会在切除标本中发现，这就需要进行额外的胃切除术和淋巴结清扫术。我们进行了一项回顾性研究以确定黏膜下层和淋巴管浸润的危险因素。
我们分析了2007年至2012年间接受ESD且患有大小为2.0 cm或更小、分化型腺癌且无溃疡的EGC患者的临床病理数据（年龄、性别、癌症位置、大体形态、多灶性、肿瘤大小、组织学分化、浸润深度以及是否存在淋巴管浸润）。
在连续接受ESD切除的208个病变中，本研究纳入了132例患者的143个病变。在16个病变中检测到黏膜下层和淋巴管浸润。多因素分析显示黏膜下层和淋巴管浸润的三个独立危险因素：中度分化或乳头状腺癌的主要组织学类型、0-IIa + IIc或IIc + IIa的大体类型以及肿瘤大小≥1.5 cm。表现出这三个危险因素中两个以上的病变与黏膜下层和淋巴管浸润发生率增加47%相关（比值比15；95%置信区间4.6 - 49.0；P < 0.0001）。
中度分化或乳头状腺癌、0-IIa + IIc或IIc + IIa以及肿瘤大小≥1.5 cm被确定为EGC中黏膜下层和淋巴管浸润的独立危险因素，而这些EGC在内镜下似乎是ESD的良好指征。对于高风险患者在ESD之前可能需要进行包括内镜超声或增强计算机断层扫描在内的仔细监测。
