Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan.
Gastrointest Endosc. 2018 Apr;87(4):1014-1022. doi: 10.1016/j.gie.2017.10.037. Epub 2017 Nov 6.
Gastric cancer is classified into differentiated and undifferentiated types according to the degree of glandular differentiation. Undifferentiated-type early gastric cancer (EGC) carries a higher risk of lymph-node metastasis than differentiated type, and therefore the indication criteria for endoscopic resection differ. This study aimed to clarify the ability of clinical predictors to distinguish between differentiated-type and undifferentiated-type EGCs.
This was a post hoc study of a multicenter prospective trial carried out in 5 Japanese hospitals, including 343 patients with cT1 EGC of ≥10 mm. According to the protocol, age, sex, and endoscopic findings of cancer (diameter, location, macroscopic type, and invasion depth) were evaluated, and the final diagnosis was confirmed from resected specimens. We evaluated the associations between these clinical factors and the histologic type of cancer and calculated the ability of the factors to diagnose differentiated-type EGC. The diagnostic ability of forceps biopsy was also calculated as a reference.
Multivariate analysis identified older age (≥72 years), male sex, larger tumor size (>30 mm), elevated type, and shallower invasion depth (cT1a) as independent significant predictors for differentiated-type EGC, with elevated type showing the highest positive likelihood ratio. The sensitivity, specificity, accuracy, and positive and negative likelihood ratios of elevated type for differentiated-type EGC were 24%, 99%, 38%, 15.7, and 0.77, respectively, compared with 96%, 86%, 95%, 7.0, and 0.04 for forceps biopsy.
Endoscopic elevated type is a significant predictor for differentiated-type EGC and may exclude undifferentiated-type EGC without the need for forceps biopsy.
胃癌根据腺体分化程度分为分化型和未分化型。未分化型早期胃癌（EGC）的淋巴结转移风险高于分化型，因此内镜切除的适应证标准也不同。本研究旨在明确临床预测因素区分分化型和未分化型 EGC 的能力。
这是在日本 5 家医院进行的多中心前瞻性试验的事后研究，纳入了 343 例 cT1 期≥10mm 的 EGC 患者。根据方案，评估了年龄、性别和癌症的内镜表现（直径、位置、大体类型和浸润深度），并从切除标本中确认了最终诊断。我们评估了这些临床因素与癌症组织学类型之间的关系，并计算了这些因素诊断分化型 EGC 的能力。还计算了活检钳诊断的能力作为参考。
多变量分析确定年龄较大（≥72 岁）、男性、较大的肿瘤大小（>30mm）、隆起型和较浅的浸润深度（cT1a）是分化型 EGC 的独立显著预测因素，隆起型的阳性似然比最高。隆起型诊断分化型 EGC 的敏感性、特异性、准确性、阳性和阴性似然比分别为 24%、99%、38%、15.7 和 0.77，而活检钳分别为 96%、86%、95%、7.0 和 0.04。
内镜隆起型是分化型 EGC 的显著预测因素，可能无需活检钳即可排除未分化型 EGC。
