Department of Gastroenterology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Gastric Surgery, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2020 Mar;23(2):285-292. doi: 10.1007/s10120-019-01003-0. Epub 2019 Sep 5.
Based on Japanese guidelines for endoscopic submucosal dissection (ESD) in undifferentiated-type early gastric cancer (UD-EGC), UD-predominant mixed-type (M-UD) EGC is considered high risk for lymph node metastasis (LNM). However, differences in LNM risk between pure UD (P-UD) and M-UD remain unclear. This study assessed risk factors for LNM considering differences between P-UD and M-UD and identified pathological features related to the lowest LNM risk.
This single-center, retrospective study included 1425 patients with UD-EGC treated with surgical resection between April 2005 and May 2017. We divided patients into those with and without LNM and compared background characteristics and post-operative pathological results between groups. Patients were further stratified based on depth, tumor diameter, ulcerative findings, lymphatic invasion, vascular invasion, and histological type to clarify post-operative pathological features associated with the lowest LNM risk.
When comparing background characteristics and post-operative pathological results, multivariate analysis showed that, in patients with LNM, tumor diameters were significantly larger, and there were higher rates of submucosal invasion, lymphatic invasion, and M-UD histological type. In patients with absence of ulcerative findings, absence of lymphatic invasion, and absence of vascular invasion, no LNM occurred among those with intramucosal P-UD tumor diameters of 1-40 mm (1-20 mm: 95% confidence interval [CI], 0-5.5%; 21-40 mm: 95% CI, 0-6.1%).
Intramucosal P-UD EGC patients with absence of ulcerative findings, absence of lymphatic invasion, absence of vascular invasion, and tumor diameters of ≤ 40 mm did not show LNM. We suggest expanding indications for ESD to include these patients.
基于日本内镜黏膜下剥离术（ESD）治疗未分化型早期胃癌（UD-EGC）指南，UD 优势混合型（M-UD）EGC 被认为具有较高的淋巴结转移（LNM）风险。然而，P-UD 和 M-UD 之间 LNM 风险的差异尚不清楚。本研究评估了考虑 P-UD 和 M-UD 之间差异的 LNM 危险因素，并确定了与最低 LNM 风险相关的病理特征。
这是一项单中心、回顾性研究，纳入了 2005 年 4 月至 2017 年 5 月期间接受手术切除治疗的 1425 例 UD-EGC 患者。我们将患者分为有 LNM 组和无 LNM 组，并比较两组的背景特征和术后病理结果。根据深度、肿瘤直径、溃疡发现、淋巴血管侵犯和组织学类型进一步分层，以明确与最低 LNM 风险相关的术后病理特征。
在比较背景特征和术后病理结果时，多变量分析显示，在有 LNM 的患者中，肿瘤直径明显更大，且黏膜下浸润、淋巴血管侵犯和 M-UD 组织学类型的发生率更高。在无溃疡发现、无淋巴血管侵犯和无血管侵犯的患者中，黏膜内 P-UD 肿瘤直径为 1-40mm（1-20mm：95%置信区间 [CI]，0-5.5%；21-40mm：95%CI，0-6.1%）的患者中未发生 LNM。
无溃疡发现、无淋巴血管侵犯、无血管侵犯且肿瘤直径≤40mm 的黏膜内 P-UD EGC 患者未发生 LNM。我们建议扩大 ESD 的适应证，包括这些患者。
