Lai Ji Fu, Xu Wen Na, Noh Sung Hoon, Lu Wei Qin
Department of Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (mainland).
Department of Surgery, Zhejiang University Hospital, Hangzhou, Zhejiang, China (mainland).
Med Sci Monit. 2016 Sep 5;22:3147-53. doi: 10.12659/msm.897311.
BACKGROUND The World Health Organization (WHO) histological classification for gastric cancer is widely accepted and used. However, its impact on predicting lymph node metastasis and recurrence in early gastric cancer (EGC) is not well studied. MATERIAL AND METHODS From 1987 to 2005, 2873 EGC patients with known WHO histological type who had undergone curative resection were enrolled in this study. In all, 637 well-differentiated adenocarcinomas (WD), 802 moderately-differentiated adenocarcinomas (MD), 689 poorly-differentiated adenocarcinomas (PD), and 745 signet-ring cell adenocarcinomas (SRC) were identified. RESULTS The distribution of demographic and clinical features in early gastric cancer among WD, MD, PD, and SRC were significantly different. Lymph node metastasis was observed in 317 patients (11.0%), with the lymph node metastasis rate being 5.3%, 14.8%, 17.0%, and 6.3% in WD, MD, PD, and SRC, respectively. Univariate and multivariate analyses indicated that gender, tumor size, gross appearance, depth of invasion, and WHO classification were significantly associated with lymph node metastasis. Recurrence was observed in 83 patients (2.9%), with the recurrence rate being 2.2%, 4.5%, 3.0%, and 1.6% in WD, MD, PD, and SRC, respectively. Multivariate analysis confirmed that MD, elevated gross type, and lymph node metastasis were independent risk factors for recurrence in EGC. MD patients showed worse disease-free survival than non-MD patients (P=0.001). CONCLUSIONS WHO classification is useful and necessary to evaluate during the perioperative management of EGC. Treatment strategies for EGC should be made prudently according to WHO classification, especially for MD patients.
背景 世界卫生组织（WHO）的胃癌组织学分类被广泛接受和使用。然而，其对早期胃癌（EGC）淋巴结转移和复发的预测作用尚未得到充分研究。材料与方法 1987年至2005年，本研究纳入了2873例已知WHO组织学类型且接受了根治性切除的EGC患者。共识别出637例高分化腺癌（WD）、802例中分化腺癌（MD）、689例低分化腺癌（PD）和745例印戒细胞腺癌（SRC）。结果 WD、MD、PD和SRC患者的EGC人口统计学和临床特征分布存在显著差异。317例患者（11.0%）出现淋巴结转移，WD、MD、PD和SRC的淋巴结转移率分别为5.3%、14.8%、17.0%和6.3%。单因素和多因素分析表明，性别、肿瘤大小、大体形态、浸润深度和WHO分类与淋巴结转移显著相关。83例患者（2.9%）出现复发，WD、MD、PD和SRC的复发率分别为2.2%、4.5%、3.0%和1.6%。多因素分析证实，MD、大体类型升高和淋巴结转移是EGC复发的独立危险因素。MD患者的无病生存期比非MD患者差（P = 0.001）。结论 WHO分类在EGC围手术期管理中进行评估是有用且必要的。应根据WHO分类谨慎制定EGC的治疗策略，尤其是对于MD患者。
