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.
Surg Endosc. 2017 Oct;31(10):4156-4164. doi: 10.1007/s00464-017-5470-8. Epub 2017 Apr 13.
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.
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.
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.
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.
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。
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。
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。
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。
