Fujikawa H, Sakamaki K, Kawabe T, Hayashi T, Aoyama T, Sato T, Oshima T, Rino Y, Morita S, Masuda M, Ogata T, Cho H, Yoshikawa T
Department of Gastrointestinal Surgery, Kanagawa Cancer Center (KCCH), Yokohama, Japan.
Ann Surg Oncol. 2015 Jul;22(7):2317-22. doi: 10.1245/s10434-015-4474-7. Epub 2015 Mar 10.
Clinical T1 gastric cancer has low metastatic potential to lymph nodes and is generally curable by local treatment. Endoscopic resection can preserve the whole stomach and does not impair the patient's quality of life; however, its indication is strictly limited to the subset of patients without nodal metastasis. The study was designed to predict reliably the patients without nodal metastasis based only on the clinical information.
We examined patients with clinical T1 disease who were treated with surgery. The clinically available information was evaluated for its ability to predict nodal metastasis by logistic regression model. Then, the predictive ability of the logistic regression model using the risk factors for nodal metastasis was evaluated by a receiver operating characteristic curve.
A total of 511 patients were entered into this study. The clinical depth (cT1a or cT1b), maximal tumor diameter, and pathological type were confirmed to be significantly different between patients with and without nodal metastasis. The cutoff value of the tumor diameter differed depending on the histology and clinical depth: 79 mm for differentiated type and 48 mm for undifferentiated type in cT1a tumors, and 43 mm for differentiated type and 11 mm for undifferentiated type in cT1b tumors. According to these criteria, 348 of the 511 patients (68.1 %) were classified to have predictive N0 status. The negative predictive value was 95.7 % (95 % confidence interval 94.0-97.5 %).
The predictive criteria based on the multivariate logistic model identified that almost two-thirds of the patients with clinical T1 gastric cancer were possible candidates for endoscopic treatment.
临床T1期胃癌发生淋巴结转移的可能性较低，通常可通过局部治疗治愈。内镜切除可保留整个胃，且不损害患者的生活质量；然而，其适应证严格限于无淋巴结转移的患者亚组。本研究旨在仅根据临床信息可靠地预测无淋巴结转移的患者。
我们检查了接受手术治疗的临床T1期疾病患者。通过逻辑回归模型评估临床可用信息预测淋巴结转移的能力。然后，通过受试者工作特征曲线评估使用淋巴结转移危险因素的逻辑回归模型的预测能力。
共有511例患者纳入本研究。有和无淋巴结转移的患者之间，临床深度（cT1a或cT1b）、肿瘤最大直径和病理类型经证实存在显著差异。肿瘤直径的截断值因组织学和临床深度而异：cT1a肿瘤中，分化型为79mm，未分化型为48mm；cT1b肿瘤中，分化型为43mm，未分化型为11mm。根据这些标准，511例患者中有348例（68.1%）被分类为具有预测性N0状态。阴性预测值为95.7%（95%置信区间94.0 - 97.5%）。
基于多变量逻辑模型的预测标准表明，几乎三分之二的临床T1期胃癌患者可能是内镜治疗的候选者。
