Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, Republic of Korea.
PLoS One. 2019 Sep 27;14(9):e0223284. doi: 10.1371/journal.pone.0223284. eCollection 2019.
Previous studies reported substantial differences between proximal and distal gastric cancer, however, most of the cases included in these studies were advanced gastric cancers (AGCs). The aim of this study was to investigate the unique characteristics of proximal early gastric cancer (EGC) by comparing with distal EGC. From March 2007 to March 2016, proximal and distal EGC patients who underwent endoscopic or surgical resection at our institution were matched 1:3 according to age and sex. We retrospectively analyzed the clinical and histopathological information. A total of 368 patients were enrolled including 92 (25%) in the proximal and 276 (75%) in the distal group. The proportion of patients who underwent surgery (56.5 vs. 20.3%, p<0.001), undifferentiated type (38.0 vs. 19.6%, p<0.001), tumor size (29.5 ±19.4 vs. 20.3 ±16.8 mm, p<0.001) and submucosal (SM) invasion (60.9 vs. 25.7%, p<0.001) were significantly higher in the proximal group than in the distal group. In multivariate analysis, the proximal location of EGC was a significant risk factor for SM invasion in the total population (odds ratio [OR], 3.541; 95% confidence interval [CI], 2.053-6.110; p<0.001), and in subgroup with EGC < 30mm (n = 279) (OR, 5.940; 95% CI, 2.974-11.862; p<0.001). In conclusion, careful therapeutic decision of proximal EGC is essential due to the different histopathological characteristics such as large tumor size and higher potential for SM invasion.
先前的研究报告称近端胃癌和远端胃癌之间存在显著差异，然而，这些研究中包含的大多数病例为进展期胃癌（AGC）。本研究旨在通过比较近端早期胃癌（EGC）和远端 EGC，探讨近端早期胃癌的独特特征。2007 年 3 月至 2016 年 3 月，我们机构按照年龄和性别 1:3 对接受内镜或手术切除的近端和远端 EGC 患者进行了匹配。我们回顾性分析了临床和组织病理学信息。共纳入 368 例患者，其中近端组 92 例（25%），远端组 276 例（75%）。手术治疗患者比例（56.5% vs. 20.3%，p<0.001）、未分化型（38.0% vs. 19.6%，p<0.001）、肿瘤大小（29.5 ±19.4 vs. 20.3 ±16.8mm，p<0.001）和黏膜下（SM）浸润（60.9% vs. 25.7%，p<0.001）在近端组均显著高于远端组。多因素分析显示，在总人群中，近端 EGC 的位置是 SM 浸润的显著危险因素（比值比 [OR]，3.541；95%置信区间 [CI]，2.053-6.110；p<0.001），在肿瘤直径<30mm 的亚组中（n=279）（OR，5.940；95%CI，2.974-11.862；p<0.001）也是如此。总之，由于肿瘤较大和 SM 浸润潜在风险较高等不同的组织病理学特征，近端 EGC 需要谨慎的治疗决策。
