Ji Tao, Zhou Fan, Wang John, Zi Li
Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong Province Department of Gastroenterology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu Province, China Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia Department of General Surgery, Linyi People's Hospital, Linyi, Shandong Province, China.
Medicine (Baltimore). 2017 Sep;96(37):e7874. doi: 10.1097/MD.0000000000007874.
This research aims to explore the potential risk factors of lymph node metastasis (LNM) for early gastric cancers in young patients.We retrospectively collected data from 4287 patients who underwent gastrectomy from January 2005 to December 2015 at Linyi People's Hospital. Of these, we enrolled 397 eligible consecutive patients who had early gastric cancer, then divided them into 2 groups according to age (≤40 years and >40 years). The association between the clinicopathological factors and LNM was analyzed by univariate and multivariate analysis.Compared to older patients (>40 years), younger patients (≤40 years) with early gastric cancer had more diffuse and mixed types (51.1% and 37.8% vs 40% and 8.3%, respectively), less proximal gastric cancer (0% vs 33.8%, P < .01) and higher LNM (33.3% vs 13%, P < .01). Univariate analysis showed tumor invasion depth (P < .01), lymphovascular invasion (P < .01), and E-cadherin expression (P = .024) were associated with LNM in the younger cohort. Multivariate analysis revealed that lymphovascular invasion (OR = 17.740, 95% CI: 1.458-215.843) was an independent risk factor for LNM (P = .024). Further analysis showed 3 patients who were within expanded endoscopic resection indications were positive for LNM.Given the high risk of lymph node involvement in young patients with early gastric cancer, both endoscopic and surgical resection procedures should be performed with caution, and active postoperative surveillance is warranted.
本研究旨在探讨青年早期胃癌患者发生淋巴结转移（LNM）的潜在危险因素。我们回顾性收集了2005年1月至2015年12月在临沂市人民医院接受胃切除术的4287例患者的数据。其中，我们纳入了397例符合条件的连续早期胃癌患者，然后根据年龄（≤40岁和>40岁）将他们分为两组。通过单因素和多因素分析来分析临床病理因素与LNM之间的关联。与老年患者（>40岁）相比，青年早期胃癌患者（≤40岁）的弥漫型和混合型更多（分别为51.1%和37.8%，而老年患者分别为40%和8.3%），近端胃癌更少（0%对33.8%，P<0.01），LNM发生率更高（33.3%对13%，P<0.01）。单因素分析显示，肿瘤浸润深度（P<0.01）、淋巴管侵犯（P<0.01）和E-钙黏蛋白表达（P=0.024）与青年队列中的LNM相关。多因素分析显示，淋巴管侵犯（OR=17.740，95%CI：1.458-215.843）是LNM的独立危险因素（P=0.024）。进一步分析显示，3例符合扩大内镜切除指征的患者LNM呈阳性。鉴于青年早期胃癌患者发生淋巴结转移的风险较高，内镜和手术切除操作均应谨慎进行，术后积极监测是必要的。
