晚期胃癌患者肿瘤浸润生长模式的预后意义。

Prognostic significance of tumour infiltration growth pattern in patients with advanced gastric cancer.

机构信息

Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.

Department of Clinical Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China.

出版信息

J Clin Pathol. 2019 Feb;72(2):165-171. doi: 10.1136/jclinpath-2018-205403. Epub 2018 Nov 22.

DOI:10.1136/jclinpath-2018-205403

PMID:30467239

Abstract

AIMS

The prognostic significance of infiltration growth pattern (INF) in patients with gastric cancer (GC) remains controversial. In the present study, we evaluated the impact of INF pattern on the prognosis of patients with advanced GC.

METHODS

A total of 1455 patients with advanced GC who underwent curative gastrectomy in our institution were retrospectively analysed. All patients were histopathologically classified as INFa/b and INFc pattern according to the Japanese Classification of Gastric Cancer. The prognostic difference between two patterns was compared and clinicopathological features were analysed.

RESULTS

The prognosis of the patients with INFc pattern was poorer than that of those with INFa/b pattern (5-year disease-free survival, INFa/b: 48.4% vs INFc: 33.5%, p < 0.001), even when they were stratified according to lymph node metastasis and the tumour, node, metastases stage. In addition, the subgroup analysis indicated that INFc pattern was significantly associated with poorer prognosis of T2-T3 stage patients (T2, INFa/b: 72.7% vs INFc: 55.4%; T3, INFa/b: 47.4% vs INFc: 33.5%; p<0.001). However, a similar result was not observed among T4a stage patients (INFa/b: 26.8% vs INFc: 24.8%, p>0.05). The prognosis of T2 stage patients with INFc pattern was similar to that of T3 stage patients with INFa/b pattern (p>0.05). Also, there was no significantly prognostic difference between T3 stage patients with INFc pattern and T4a stage patients (p>0.05). The multivariate analysis indicated that INF pattern was an independent prognostic factor for patients with advanced GC (HR 1.259, 95%CI 1.089 to 1.454).

CONCLUSION

In view of its prognostic significance, histopathological evaluation of INF pattern in surgically resected specimens should be recommended in patients with advanced GC.

摘要

目的

浸润生长模式（INF）在胃癌（GC）患者中的预后意义仍存在争议。本研究旨在评估 INF 模式对进展期 GC 患者预后的影响。

方法

回顾性分析 1455 例在我院接受根治性胃切除术的进展期 GC 患者。所有患者均根据日本胃癌分类法病理组织学分为 INFa/b 和 INFc 型。比较两种模式的预后差异，并分析临床病理特征。

结果

INFc 型患者的预后较 INFa/b 型差（5 年无病生存率，INFa/b：48.4% vs INFc：33.5%，p<0.001），即使在按淋巴结转移和肿瘤、淋巴结、转移分期分层后也是如此。此外，亚组分析表明，INFc 型与 T2-T3 期患者预后较差显著相关（T2 期，INFa/b：72.7% vs INFc：55.4%；T3 期，INFa/b：47.4% vs INFc：33.5%；p<0.001）。然而，在 T4a 期患者中未观察到类似结果（INFa/b：26.8% vs INFc：24.8%，p>0.05）。INFc 型 T2 期患者的预后与 INFa/b 型 T3 期患者相似（p>0.05）。此外，INFc 型 T3 期患者与 T4a 期患者之间的预后也无显著差异（p>0.05）。多因素分析表明，INF 模式是进展期 GC 患者的独立预后因素（HR 1.259，95%CI 1.089 至 1.454）。