Department of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
Department of Pathology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
World J Gastroenterol. 2018 Jan 7;24(1):87-95. doi: 10.3748/wjg.v24.i1.87.
To investigate the relationship between histological mixed-type of early gastric cancer (EGC) in the mucosa and submucosa and lymph node metastasis (LNM).
This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated (pure D), pure undifferentiated (pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. Furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.
Of the 298 patients, 165 (55.4%) had mucosa-confined EGC and 133 (44.6%) had submucosa-invasive EGC. Only 13 (7.9%) cases of mucosa-confined EGC and 30 (22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion (OR = 4.58, 95%CI: 1.23-16.97, = 0.023), pure U type (OR = 4.97, 95%CI: 1.21-20.39, = 0.026), and mixed-type (OR = 5.84, 95%CI: 1.05-32.61, = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixed-type group ( = 0.012) and pure U group ( = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group ( = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixed-type ( = 0.012) and pure U group ( = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group ( = 0.375). Multivariate logistic analysis showed that only female sex (OR = 5.83, 95%CI: 1.64-20.70, = 0.028) and presence of lymphovascular invasion (OR = 13.18, 95%CI: 1.39-125.30, = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC ( = 0.106).
For mucosal EGC, histological mixed-type is not an independent risk factor for LNM and could be managed in the same way as the undifferentiated type.
探讨黏膜和黏膜下早期胃癌（EGC）组织学混合型与淋巴结转移（LNM）的关系。
本研究纳入 2005 年至 2012 年间接受 EGC 胃切除术的 298 例患者。根据显微镜下观察到的分化和未分化成分的比例，将病变分为纯分化型（纯 D 型）、纯未分化型（纯 U 型）和混合型。我们回顾了三组的临床病理特征，包括年龄、性别、部位、大小、大体类型、血管淋巴管侵犯、溃疡和 LNM。此外，我们评估了黏膜内 EGC 中 LNM 的预测因素。
298 例患者中，165 例（55.4%）为黏膜内 EGC，133 例（44.6%）为黏膜下浸润性 EGC。仅 13 例（7.9%）黏膜内 EGC 和 30 例（22.6%）黏膜下浸润性 EGC 观察到有 LNM。黏膜下浸润（OR=4.58，95%CI：1.23-16.97， = 0.023）、纯 U 型（OR=4.97，95%CI：1.21-20.39， = 0.026）和混合型（OR=5.84，95%CI：1.05-32.61， = 0.044）是 EGC 发生 LNM 的独立危险因素。在黏膜内 EGC 中，混合型（ = 0.012）和纯 U 型（ = 0.010）的 LNM 发生率高于纯 D 型，但混合型与纯 U 型之间无显著差异（ = 0.739）。同样，在黏膜下浸润性 EGC 中，混合型（ = 0.012）和纯 U 型（ = 0.009）的 LNM 发生率高于纯 D 型，但混合型与纯 U 型之间无显著差异（ = 0.375）。多变量 logistic 分析显示，仅女性（OR=5.83，95%CI：1.64-20.70， = 0.028）和存在血管淋巴管侵犯（OR=13.18，95%CI：1.39-125.30， = 0.020）是黏膜内 EGC 发生 LNM 的独立危险因素，而组织学类型不是黏膜内 EGC 发生 LNM 的独立危险因素（ = 0.106）。
对于黏膜 EGC，组织学混合型不是 LNM 的独立危险因素，可按未分化型进行相同的管理。
