Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Surg Endosc. 2017 Nov;31(11):4419-4424. doi: 10.1007/s00464-017-5490-4. Epub 2017 Apr 4.
Lymph node (LN) metastasis is found in only about 5-10% of the patients who undergo additional surgery after non-curative endoscopic resection. Lymphatic invasion after endoscopic submucosal dissection (ESD) is regarded as non-curative resection due to risk of reginal LN metastasis. This study was aimed to identify clinicopathologic predictive factors for LN metastasis in early gastric cancer (EGC) with lymphatic invasion after endoscopic resection.
Among a total of 2036 patients who underwent endoscopic resection for EGC at Samsung Medical Center from April 2000 to May 2011, 146 patients were diagnosed with lymphatic invasion. And 123 patients who had gastrectomy with LN dissection due to presence of lymphatic invasion as one of the non-curative factors were included in this study. Demographics, endoscopic tumor findings, histological findings, surgical findings with pathologic reports, and follow-up data were collected from the patient's medical records. Pathological re-evaluation of resected specimens was performed.
Among a total of 123 patients, LN metastases were found in seven patients (5.7%). The univariate analysis revealed that the LN metastasis was significantly more frequent in patients with certain morphology of lymphatic invasion that shows adhesion to endothelium of lymphatic tumor emboli (p = 0.016), higher number of lymphatic tumor emboli in whole section (p < 0.001) and papillary adenocarcinoma component (p = 0.024). In multivariate analysis, the number of lymphatic tumor emboli [OR 93.5, 95% CI (2.62-3330.81)] and the presence of papillary adenocarcinoma component [OR 552.5, 95% CI (1.20-254871.81)] were identified as independent predictors of LN metastasis in patients with lymphatic invasion after endoscopic resection.
The number of lymphatic tumor emboli and the presence of papillary adenocarcinoma component were significant predictors for LN metastasis in patients with lymphatic invasion after endoscopic resection.
非治愈性内镜切除术后，仅有约 5-10%的患者会发现淋巴结（LN）转移。内镜黏膜下剥离术（ESD）后发生淋巴管浸润被认为是不可治愈的切除，因为存在区域 LN 转移的风险。本研究旨在确定内镜切除术后伴有淋巴管浸润的早期胃癌（EGC）中 LN 转移的临床病理预测因素。
在 2000 年 4 月至 2011 年 5 月期间，三星医疗中心对 2036 例 EGC 患者进行了内镜切除，其中 146 例患者被诊断为淋巴管浸润。本研究纳入了 123 例因淋巴管浸润等非治愈因素行胃切除术且行淋巴结清扫术的患者。从患者的病历中收集了人口统计学、内镜肿瘤表现、组织学发现、手术发现和病理报告以及随访数据。对切除标本进行了病理重新评估。
在总共 123 例患者中，7 例（5.7%）发现 LN 转移。单因素分析显示，具有淋巴管浸润特定形态的患者，即肿瘤栓子与淋巴管内皮粘连（p=0.016），整个切片中淋巴管肿瘤栓子数量较高（p<0.001）和存在乳头状腺癌成分（p=0.024），LN 转移更为常见。多因素分析显示，淋巴管肿瘤栓子数量[OR 93.5，95%CI（2.62-3330.81）]和存在乳头状腺癌成分[OR 552.5，95%CI（1.20-254871.81）]是内镜切除术后淋巴管浸润患者 LN 转移的独立预测因素。
淋巴管肿瘤栓子数量和存在乳头状腺癌成分是内镜切除术后淋巴管浸润患者 LN 转移的显著预测因素。
