弥漫型和肠型早期胃癌患者的淋巴结转移率和生存率相当：一项大型基于人群的研究。
Comparable rates of lymph node metastasis and survival between diffuse type and intestinal type early gastric cancer patients: a large population-based study.
机构信息
Department of Gastroenterology and Hepatology, Shanghai Minhang TCM Hospital, Shanghai, China.
Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
出版信息
Gastrointest Endosc. 2019 Jul;90(1):84-95.e10. doi: 10.1016/j.gie.2019.03.002. Epub 2019 Mar 15.
BACKGROUND AND AIMS
Limited evidence and contradictory results exist regarding the impact of Lauren type, namely diffuse and intestinal types, of lymph node metastasis (LNM) and prognosis for early gastric cancer (EGC). We aimed to compare LNM and prognosis between diffuse and intestinal type EGCs using comprehensive statistical analysis.
METHODS
The Surveillance, Epidemiology, and End Results (SEER) database was used to identify all patients with surgically resected, histologically diagnosed, intestinal or diffuse type EGC. Multivariate logistic regression, multivariate Cox regression, multivariate competing risk model, and propensity score matching were used to analyze association the Lauren type and LNM or prognosis.
RESULTS
We identified 5593 EGCs from the SEER database, including 4376 intestinal types and 1217 diffuse types. No positive association was found between LNM and Lauren type (odds ratio, .93; 95% confidence interval [CI], .70-1.24; P = .62) after adjustment for other risk factors. Moreover, diffuse-type EGCs showed a similar prognosis to intestinal type EGCs in both multivariate Cox regression (HR [hazard ratio], .95; 95% CI, .77-1.18; P = .66) and the multivariate competing risk model (subdistribution HR [SHR], .99; 95% CI, .80-1.22; P = .926). Propensity score matching was used, and 733 diffuse types were matched with 733 intestinal types. We did not find any association between the Lauren type and LNM (odds ratio, .98; 95% CI, .71-1.37; P = .934) or prognosis in the univariate Cox regression (HR, .98; 95% CI, .76-1.26; P = .893) and univariate competing risk model (SHR, .98; 95% CI, .76-1.26; P = .893).
CONCLUSIONS
Diffuse-type EGC may have a comparable risk of LNM and prognosis to intestinal-type EGC. Nevertheless, these results should be carefully interpreted with caution when choosing endoscopic resection instead of surgery, because the treatment choice for EGC depends on the risk of lymphovascular invasion rather than LNM rate or prognosis.
背景与目的
关于肠型和弥漫型（即弥散型和肠型）淋巴结转移（LNM）和早期胃癌（EGC）预后的影响，证据有限且结果相互矛盾。我们旨在使用综合统计分析比较弥漫型和肠型 EGC 之间的 LNM 和预后。
方法
使用监测、流行病学和最终结果（SEER）数据库确定所有接受手术切除、组织学诊断为肠型或弥漫型 EGC 的患者。多变量逻辑回归、多变量 Cox 回归、多变量竞争风险模型和倾向评分匹配用于分析 Lauren 型与 LNM 或预后的关系。
结果
我们从 SEER 数据库中确定了 5593 例 EGC，其中 4376 例为肠型，1217 例为弥漫型。在调整其他危险因素后，LNM 与 Lauren 型之间未发现正相关（比值比，0.93；95%置信区间[CI]，0.70-1.24；P=0.62）。此外，在多变量 Cox 回归（风险比[HR]，0.95；95%CI，0.77-1.18；P=0.66）和多变量竞争风险模型（亚分布 HR[SHR]，0.99；95%CI，0.80-1.22；P=0.926）中，弥漫型 EGC 的预后与肠型 EGC 相似。使用倾向评分匹配，733 例弥漫型与 733 例肠型相匹配。我们在单变量 Cox 回归（比值比，0.98；95%CI，0.71-1.37；P=0.934）和单变量竞争风险模型（SHR，0.98；95%CI，0.76-1.26；P=0.893）中均未发现 Lauren 型与 LNM 或预后之间存在关联。
结论
弥漫型 EGC 的 LNM 风险和预后可能与肠型 EGC 相当。然而，在选择内镜切除而不是手术时，这些结果应谨慎解释，因为 EGC 的治疗选择取决于淋巴管浸润的风险，而不是 LNM 率或预后。
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