Asakawa Yukiko, Ohtaka Masahiko, Maekawa Shinya, Fukasawa Mitsuharu, Nakayama Yasuhiro, Yamaguchi Tatsuya, Inoue Taisuke, Uetake Tomoyoshi, Sakamoto Minoru, Sato Tadashi, Kawaguchi Yoshihiko, Fujii Hideki, Mochizuki Kunio, Hada Masao, Oyama Toshio, Yasumura Tomotaka, Omata Kosaku, Nishiyama Atsushi, Naito Keiichi, Hata Hideo, Haba Yoshiaki, Miyata Kazuyuki, Saitoh Haruhisa, Yamadera Yoichi, Miura Kazuo, Kawaoi Akira, Abe Tohru, Tsunoda Hajime, Honda Yuji, Kurosaki Masayuki, Enomoto Nobuyuki
Yukiko Asakawa, Masahiko Ohtaka, Shinya Maekawa, Mitsuharu Fukasawa, Yasuhiro Nakayama, Tatsuya Yamaguchi, Taisuke Inoue, Tomoyoshi Uetake, Minoru Sakamoto, Tadashi Sato, Nobuyuki Enomoto, First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan.
World J Gastroenterol. 2015 Mar 7;21(9):2683-92. doi: 10.3748/wjg.v21.i9.2683.
To study how lymph node metastasis (LNM) risk is stratified in undifferentiated-type early gastric cancer (undiff-EGC) dependent on combinations of risk factors.
Five hundred and sixty-seven cases with undiff-EGC undergoing gastrectomy with lymphadenectomy were examined retrospectively. Using clinicopathological factors of patient age, location, size, an endoscopic macroscopic tumor form, ulceration, depth, histology, lymphatic involvement (LI) and venous involvement (VI), LNM risk was examined and stratified by conventional statistical analysis and data-mining analysis.
LNM was positive in 44 of 567 cases (7.8%). Univariate analysis revealed > 2 cm, protrusion, submucosal (sm), mixed type, LI and VI as significant prognostic factors and > 2 cm and LI-positive were independent factors by multivariate analysis. In preoperatively evaluable factors excluding LVI, sm and > 2 cm were independent factors. According to the depth and size, cases were categorized into the low-risk group [m and ≤ 2 cm, 0% (LNM incidence)], the moderate-risk group (m and > 2 cm, 5.6%; and sm and ≤ 2 cm, 6.0%), and the high-risk group (sm and > 2 cm, 19.3%). On the other hand, LNM occurred in 1.4% in all LI-negative cases, greatly lower than 28.2% in all LI-positive cases, and LNM incidence was low in LI-negative cases even in the moderate- and high-risk groups.
LNM-related factors in undiff-EGC were depth and size preoperatively while those were LI and size postoperatively. Among these factors, LI was the most significantly correlated factor.
研究如何根据危险因素组合对未分化型早期胃癌（undiff-EGC）的淋巴结转移（LNM）风险进行分层。
回顾性研究567例行胃癌切除术及淋巴结清扫术的未分化型早期胃癌病例。利用患者年龄、病变部位、大小、内镜下宏观肿瘤形态、溃疡、深度、组织学、淋巴侵犯（LI）和静脉侵犯（VI）等临床病理因素，通过传统统计分析和数据挖掘分析对LNM风险进行检测和分层。
567例中有44例（7.8%）LNM呈阳性。单因素分析显示，>2 cm、隆起型、黏膜下层（sm）、混合型、LI和VI是显著的预后因素，多因素分析显示>2 cm和LI阳性是独立因素。在排除LVI、sm和>2 cm的术前可评估因素中，sm和>2 cm是独立因素。根据深度和大小，病例分为低风险组[m且≤2 cm，0%（LNM发生率）]、中风险组（m且>2 cm，5.6%；sm且≤2 cm，6.0%）和高风险组（sm且>2 cm，19.3%）。另一方面，所有LI阴性病例的LNM发生率为1.4%，远低于所有LI阳性病例的28.2%，即使在中风险组和高风险组中，LI阴性病例的LNM发生率也较低。
未分化型早期胃癌中与LNM相关的因素术前为深度和大小，术后为LI和大小。在这些因素中，LI是最显著的相关因素。
