Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China.
Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China.
J Dig Dis. 2017 Oct;18(10):556-565. doi: 10.1111/1751-2980.12545.
To investigate risk factors of lymph node metastasis (LNM) in early gastric carcinoma (EGC) in four tertiary medical centers in Jiangsu Province, China.
Among 10 097 consecutive combined gastric cancer radical resections, 1903 EGC were identified and reviewed, 283 excluded and 1620 included in the study. All pathological and some endoscopic reports were reviewed for patients' characteristics, tumor location, gross features, and the number of lymph nodes retrieved and involved. Two pathologists independently investigated the pathological features of tumor type, differentiation, invasion depth, lymphovascular invasion (LVI), and perineural invasion. The data were statistically analyzed to identify risk factors for LNM.
The average number of lymph nodes retrieved was 17.5 per patient. LNM was diagnosed in 15.5%. By univariate analysis, significant risk factors for LNM included age ≥ 41 years, female sex, size over 1 cm, submucosal invasion, poor differentiation, poorly cohesive carcinoma, micropapillary adenocarcinoma, adenocarcinoma mixed with signet-ring cell carcinoma, LVI, perineural invasion, and distal gastric location. By multivariate analysis, independent risk factors for LNM were size ≥ 3 cm (odds ratio [OR] 1.9), poor differentiation (OR 2.5), adenocarcinoma mixed with signet-ring cell carcinoma (OR 1.7), LVI (OR 5.8) and submucosal invasion (OR 2.9). In contrast, size < 3 cm and ulcer were not significant risk factors. Early cardiac carcinoma (OR 0.4) had significantly lower risk.
Independent risk factors for LNM in EGC in Chinese patients included tumor size ≥ 3 cm, poor differentiation, submucosal invasion, adenocarcinoma mixed with signet-ring cell carcinoma and LVI. Early cardiac carcinoma had a significantly lower risk for LNM.
在中国江苏省的四家三级医疗中心调查早期胃癌（EGC）淋巴结转移（LNM）的危险因素。
在连续的 10097 例胃癌根治性切除术中，发现并回顾了 1903 例 EGC，排除了 283 例，纳入了 1620 例进行研究。所有病理和部分内镜报告均用于评估患者特征、肿瘤部位、大体特征、以及检出和累及的淋巴结数量。两位病理学家独立调查了肿瘤类型、分化、浸润深度、淋巴血管侵犯（LVI）和神经周围侵犯的病理特征。对数据进行统计学分析，以确定 LNM 的危险因素。
每位患者平均检出的淋巴结数量为 17.5 个。诊断出 LNM 的比例为 15.5%。通过单因素分析，LNM 的显著危险因素包括年龄≥41 岁、女性、肿瘤大小超过 1cm、黏膜下浸润、低分化、非典型性、微乳头状腺癌、腺癌混合印戒细胞癌、LVI、神经周围侵犯和胃远端位置。通过多因素分析，LNM 的独立危险因素包括肿瘤大小≥3cm（优势比[OR]1.9）、低分化（OR 2.5）、腺癌混合印戒细胞癌（OR 1.7）、LVI（OR 5.8）和黏膜下浸润（OR 2.9）。相比之下，肿瘤大小<3cm 和溃疡不是显著的危险因素。早期贲门癌（OR 0.4）的 LNM 风险显著降低。
中国患者 EGC 发生 LNM 的独立危险因素包括肿瘤大小≥3cm、低分化、黏膜下浸润、腺癌混合印戒细胞癌和 LVI。早期贲门癌 LNM 的风险显著降低。
