淋巴间质型早期胃癌的临床病理特征及内镜黏膜下剥离术的可行性。
Clinicopathologic features of early gastric carcinoma with lymphoid stroma and feasibility of endoscopic submucosal dissection.
机构信息
Departments of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
Departments of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
出版信息
Surg Endosc. 2017 Oct;31(10):4156-4164. doi: 10.1007/s00464-017-5470-8. Epub 2017 Apr 13.
BACKGROUND
Gastric carcinoma with lymphoid stroma (GCLS) is a rare disease known to have unique features and a favorable prognosis. This study aimed to determine the clinicopathologic features of early GCLS (EGCLS) and define the feasibility of endoscopic submucosal dissection (ESD) for EGCLS.
METHODS
We performed a retrospective analysis of 70 EGCLS patients treated via ESD or surgery and 1626 patients who underwent surgical resection for early non-GCLS (ENGCLS) between January 2007 and December 2014 at Pusan National University Hospital, Busan, Republic of Korea.
RESULTS
The mean age of EGCLS patients was 58 years (range 36-77 years); a male predominance (3.7:1) was observed, and 81.4% showed Epstein-Barr virus positivity. Compared with ENGCLS, EGCLS was macroscopically more elevated (34.3 vs. 18.0%, P = 0.003) and located more proximally (upper third: 37.1 vs. 9.7%, P < 0.001). Tumor size was smaller (2.1 ± 1.1 vs. 3.1 ± 2.0 cm, P < 0.001), but submucosal invasion was more frequent (77.1 vs. 44.4%, P < 0.001) and deeper in the EGCLS group. Among the 59 EGCLS patients who were treated surgically, only two (3.4%) showed lymph node metastasis (LNM). Despite submucosal invasion, EGCLS showed a lower LNM rate (4.0 vs. 19.4%, P = 0.007) than ENGCLS, even in patients with SM3 EGCLS (5.3 vs. 24.5%, P = 0.007). There were no recurrences in the available ten patients who underwent ESD alone during a mean follow-up of 37.2 months.
CONCLUSIONS
In this study, we observed unique clinicopathologic features with a very low LNM rate in EGCLS. We consider ESD a potentially curative treatment strategy for EGCLS despite deep submucosal invasion, especially in patients with poor performance status and significant comorbidities.
背景
淋巴上皮瘤样胃癌（GCLS）是一种罕见的疾病，具有独特的特征和良好的预后。本研究旨在确定早期 GCLS（EGCLS）的临床病理特征，并确定内镜黏膜下剥离术（ESD）治疗 EGCLS 的可行性。
方法
我们对 2007 年 1 月至 2014 年 12 月在韩国釜山大学医院接受 ESD 或手术治疗的 70 例 EGCLS 患者和 1626 例接受早期非 GCLS（ENGCLS）手术切除的患者进行了回顾性分析。
结果
EGCLS 患者的平均年龄为 58 岁（范围 36-77 岁）；男性居多（3.7:1），81.4%的患者呈 Epstein-Barr 病毒阳性。与 ENGCLS 相比，EGCLS 更呈隆起型（34.3%比 18.0%，P=0.003），位置更靠近近端（上三分之一：37.1%比 9.7%，P<0.001）。肿瘤直径较小（2.1±1.1cm 比 3.1±2.0cm，P<0.001），但黏膜下浸润更为常见（77.1%比 44.4%，P<0.001），且 EGCLS 组更深。在接受手术治疗的 59 例 EGCLS 患者中，仅 2 例（3.4%）出现淋巴结转移（LNM）。尽管有黏膜下浸润，EGCLS 的 LNM 率仍较低（4.0%比 19.4%，P=0.007），即使在 SM3 期 EGCLS 患者中（5.3%比 24.5%，P=0.007）也是如此。在平均随访 37.2 个月的 10 例单独接受 ESD 治疗的可随访患者中，无复发。
结论
在这项研究中，我们观察到 EGCLS 具有独特的临床病理特征，且淋巴结转移率非常低。我们认为 ESD 是一种有潜在治愈作用的治疗策略，即使在黏膜下浸润较深的情况下，特别是在身体状况不佳和合并症较多的患者中。
Zotero 插件