Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
Asian J Surg. 2018 Sep;41(5):462-466. doi: 10.1016/j.asjsur.2017.04.004. Epub 2017 Jul 18.
BACKGROUND/OBJECTIVE: Mixed-type early gastric cancer (differentiated and undifferentiated components) incurs a higher risk of lymph node metastasis than pure-type early gastric cancer (only differentiated or only undifferentiated components). Therefore, we investigated the expansion of lymph node metastasis in mixed-type submucosal invasive gastric cancer in order to establish the most appropriate treatment for mixed-type cancer.
We retrospectively analyzed 279 consecutive patients with submucosal invasive gastric cancer who underwent curative gastrectomy for gastric cancer between 1996 and 2015. We classified the patients into the mixed-type and pure-type groups according to histologic examination and evaluated the expansion of lymph node metastasis.
The rate of lymph node metastasis was 23.7% (66/279) in the total patients, 36.4% (36/99) in the mixed-type group, and 16.6% (30/180) in the pure-type group. The significant independent risk factors for lymph node metastasis were tumor size ≥2.0 cm (P = 0.014), mixed-type gastric cancer (P < 0.001), and lymphatic invasion (P < 0.001). Lymphatic invasion and lymph node metastasis had a strong relationship in mixed-type group. The rates of no. 7 lymph node metastasis in the total patients and mixed-type group were 2.9% (8/279) and 5.1% (5/99), respectively; the rates of no. 8a lymph node metastasis were 1.4% (4/279) and 4.0% (4/99), respectively.
Mixed histological type is an independent risk factor for lymph node metastasis. Lymph node metastasis in mixed-type gastric cancer involves expansion to the no. 7 and no. 8a lymph nodes. Therefore, lymphadenectomy for mixed-type submucosal invasive gastric cancer requires D1+ or D2 dissection.
背景/目的：混合型早期胃癌（分化型和未分化型成分）比单纯型早期胃癌（仅分化型或仅未分化型成分）发生淋巴结转移的风险更高。因此，我们研究了混合型黏膜下浸润性胃癌的淋巴结转移扩展情况，以便为混合型癌症制定最合适的治疗方案。
我们回顾性分析了 1996 年至 2015 年间 279 例接受根治性胃切除术的黏膜下浸润性胃癌患者。我们根据组织学检查将患者分为混合型和单纯型组，并评估了淋巴结转移的扩展情况。
总患者中淋巴结转移率为 23.7%（66/279），混合型组为 36.4%（36/99），单纯型组为 16.6%（30/180）。淋巴结转移的独立危险因素为肿瘤直径≥2.0cm（P=0.014）、混合型胃癌（P<0.001）和淋巴管浸润（P<0.001）。混合型组中淋巴管浸润和淋巴结转移之间存在很强的关系。总患者和混合型组中第 7 组淋巴结转移的发生率分别为 2.9%（8/279）和 5.1%（5/99），第 8a 组淋巴结转移的发生率分别为 1.4%（4/279）和 4.0%（4/99）。
混合型组织学类型是淋巴结转移的独立危险因素。混合型胃癌的淋巴结转移涉及到第 7 组和第 8a 组淋巴结的扩展。因此，混合型黏膜下浸润性胃癌的淋巴结切除术需要 D1+或 D2 清扫术。
