Department of Trauma Surgery, Regional Trauma Center, Gachon Gil Hospital, Incheon, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Gastrointest Endosc. 2016 May;83(5):896-901. doi: 10.1016/j.gie.2015.08.051. Epub 2015 Sep 3.
Endoscopic resection for mucosal gastric cancer (MGC) is highly recommended in the absence of lymph node metastasis (LNM). We aimed to clarify the risk factors for LNM in MGC and to investigate the association of LNM with the indication criteria for endoscopic submucosal dissection (ESD).
A retrospective cohort study was performed on 3951 patients with MGC who underwent radical gastrectomy at the Samsung Medical Center in Seoul, Republic of Korea, between September 1994 and September 2010.
Of the patients with MGC, 101 (2.60%) were positive for LNM. Multivariate analysis, followed by univariate analysis, revealed the following risk factors for LNM in MGC: large tumor size, undifferentiated tumor type, lymphatic invasion, perineural invasion, and associated ulceration in the tumor (hazard ratio 1.25, 7.49, 20.65, 23.45, and 4.07, respectively). Patients without LNM had significantly increased survival and/or recurrence-free survival rates than patients with LNM (188.4/209.8 months vs 169.5/188.0 months; P = .029/.004, respectively). Only 3 of 1065 patients (0.3%) who met the absolute indication criteria for ESD had LNM. Of those who met the expanded indication criteria for ESD, 11 of 2678 patients (0.4%) had LNM. LNM also was found in 2 patients who had a differentiated tumor <0.5 cm without ulceration.
The risk for LNM was very low when patients with MGC met the absolute and/or expanded criteria for endoscopic resection, which meant the indication criteria for ESD was safe and acceptable. However, although the risk for LNM is very low, it should not be considered negligible in endoscopic resection.
对于无淋巴结转移（LNM）的黏膜下胃癌（MGC），强烈推荐进行内镜下切除术。本研究旨在明确 MGC 发生 LNM 的危险因素，并探讨 LNM 与内镜黏膜下剥离术（ESD）适应证标准的相关性。
对 1994 年 9 月至 2010 年 9 月期间在韩国首尔三星医疗中心接受根治性胃切除术的 3951 例 MGC 患者进行了回顾性队列研究。
在 MGC 患者中，有 101 例（2.60%）存在 LNM。多变量分析后，单变量分析显示，MGC 发生 LNM 的以下危险因素为：肿瘤较大、未分化肿瘤类型、淋巴管浸润、神经周围浸润和肿瘤相关溃疡（风险比 1.25、7.49、20.65、23.45 和 4.07）。无 LNM 的患者与有 LNM 的患者相比，生存和/或无复发生存率显著提高（188.4/209.8 个月比 169.5/188.0 个月；P=.029/.004）。在符合 ESD 绝对适应证标准的 1065 例患者中，仅 3 例（0.3%）发生 LNM。在符合 ESD 扩展适应证标准的 2678 例患者中，有 11 例（0.4%）发生 LNM。在未发生溃疡的分化型肿瘤<0.5cm 的 2 例患者中也发现了 LNM。
当 MGC 患者符合内镜切除术的绝对和/或扩展适应证标准时，发生 LNM 的风险非常低，这意味着 ESD 的适应证标准是安全且可接受的。然而，尽管 LNM 的风险非常低，但在进行内镜切除时不应认为其可以忽略不计。
