Kanda Mitsuro, Mizuno Akira, Fujii Tsutomu, Shimoyama Yoshie, Yamada Suguru, Tanaka Chie, Kobayashi Daisuke, Koike Masahiko, Iwata Naoki, Niwa Yukiko, Hayashi Masamichi, Takami Hideki, Nakayama Goro, Sugimoto Hiroyuki, Fujiwara Michitaka, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Pathology, Nagoya University Hospital, Nagoya, Japan.
Ann Surg Oncol. 2016 Jun;23(6):1934-40. doi: 10.1245/s10434-016-5102-x. Epub 2016 Feb 3.
In East Asia, the tumor infiltrative pattern (INF) has been routinely evaluated by hematoxylin and eosin-stained sections as a pathologic characteristic of surgically resected specimens.
The infiltrative pattern of gastric cancer (GC) has been histopathologically classified as INFa (expansive growth), INFb (intermediate type) and INFc (infiltrative growth) according to the Japanese Classification of Gastric Carcinoma. The prognostic value and characteristics of the disease recurrence pattern for each INF type were assessed in 785 patients with various stages of GC and also in 243 patients with stages 2 and 3 GC.
Comparison of the overall survival experienced by patients independently of stage showed that INF was significantly associated with prognosis. Specifically, peritoneal metastasis was present in 91 % of stage 4 patients in the INFc group, whereas hepatic metastasis was present in 39 % of stage 4 patients in the INFa and INFb group. After curative gastrectomy of patients with stages 2 or 3 GC, INF was not significantly associated with survival. The prevalence of peritoneal recurrence was significantly higher in the INFc group than in the INFa and INFb group, whereas the prevalence of hepatic recurrence was significantly higher in the INFa and INFb group than in the INFc group. Multivariate analysis identified INFc as an independent risk factor for peritoneal recurrence after curative gastrectomy. The association of the INF type with the incidence of peritoneal recurrence was observed with all disease stages regardless whether the patient was given adjuvant chemotherapy or not.
Evaluation of the INF type shows promise for its role as a predictor of postoperative recurrence sites in patients with GC.
在东亚地区，肿瘤浸润模式（INF）已通过苏木精和伊红染色切片常规评估，作为手术切除标本的病理特征。
根据日本胃癌分类，胃癌（GC）的浸润模式在组织病理学上分为INFa（膨胀性生长）、INFb（中间型）和INFc（浸润性生长）。对785例不同分期的GC患者以及243例2期和3期GC患者评估了每种INF类型的疾病复发模式的预后价值和特征。
对各阶段患者总体生存情况的比较显示，INF与预后显著相关。具体而言，INFc组4期患者中91%出现腹膜转移，而INFa和INFb组4期患者中39%出现肝转移。2期或3期GC患者行根治性胃切除术后，INF与生存无显著相关性。INFc组腹膜复发的发生率显著高于INFa和INFb组，而INFa和INFb组肝复发的发生率显著高于INFc组。多因素分析确定INFc是根治性胃切除术后腹膜复发的独立危险因素。无论患者是否接受辅助化疗，在所有疾病阶段均观察到INF类型与腹膜复发发生率之间的关联。
评估INF类型有望作为GC患者术后复发部位的预测指标。
