基于未分化早期胃癌患者淋巴结转移风险的内镜治疗适应证。
Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer.
机构信息
Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu Province, China; Department of Pathology, Gansu Province People's Hospital, Lanzhou, 730000, Gansu Province, China.
Department of Pathology, Gansu Province People's Hospital, Lanzhou, 730000, Gansu Province, China.
出版信息
Asian J Surg. 2020 Oct;43(10):973-977. doi: 10.1016/j.asjsur.2019.12.002. Epub 2020 Jan 18.
BACKGROUND
Despite the risk of lymph node metastasis (LNM), the indications of endoscopic submucosal dissection (ESD) has expanded to undifferentiated type (UD-type) early gastric cancer (EGC). There is debate as to whether the endoscopic resection can be used. This study was conducted to evaluate risk factors for LNM in undifferentiated early gastric cancer, implications for the indication of the ESD so as to providing evidence for proper clinical management for UD-type EGC.
METHOD
We retrospectively analyzed 203 patients with UD-type EGC who underwent gastrectomy for primary gastric adenocarcinoma between 2012 and 2017. We evaluated the relationship between the clinicopathological factors and the presence of LNM using univariable and multivariable logistic regression analyses.
RESULTS
A total of 203 UD-type EGC patients were enrolled, and LNM was positive in 40 cases (19.7%). Multivariable logistic regression analysis identified three independent risk factors for LNM, the tumor size (≥2.0 cm, P < 0.001), depth of invasion (P < 0.001), and lymphatic vessel involvement (LVI, P < 0.001). LNM was observed in 5.9% patients without the three predictive factors in UD-type EGC, whereas 7.7% and 37.7% of patients with one and two risk factors had LNM, respectively. In contrast, the LNM rate was up to be 66.7% in patients with three factors. Of 41 patients satisfying the expanded indication of ESD, 3 patients (7.3%) showed LNM. LNM was not found in any of 12 patients with small intramucosal lesions (<1.0 cm) without LVI.
CONCLUSIONS
LNM-related risk factors were tumor larger than 2.0 cm, submucosal invasion, and the presence of LVI in UD-type EGC. ESD alone may be sufficient treatment for the intramucosal UD-type EGC that is smaller than 1.0 cm in size. When endoscopically resected specimens show unexpectedly larger tumor size, unexpected submucosal and LVI than that determined at pre-ESD endoscopic diagnosis, an additional gastrectomy with lymphadenectomy should be considered.
背景
尽管存在淋巴结转移（LNM）的风险，但内镜黏膜下剥离术（ESD）的适应证已扩展到未分化型（UD 型）早期胃癌（EGC）。对于是否可以进行内镜切除存在争议。本研究旨在评估未分化型早期胃癌发生 LNM 的危险因素，为 ESD 的适应证提供依据，为 UD 型 EGC 的合理临床管理提供证据。
方法
我们回顾性分析了 2012 年至 2017 年间因原发性胃腺癌行胃切除术的 203 例 UD 型 EGC 患者。我们使用单变量和多变量逻辑回归分析评估了临床病理因素与 LNM 之间的关系。
结果
共纳入 203 例 UD 型 EGC 患者，其中 40 例（19.7%）发生 LNM。多变量逻辑回归分析确定了 LNM 的三个独立危险因素，肿瘤大小（≥2.0cm，P<0.001）、浸润深度（P<0.001）和淋巴管浸润（LVI，P<0.001）。在 UD 型 EGC 中，无三个预测因素的患者中 LNM 的发生率为 5.9%，而有一个和两个危险因素的患者中 LNM 的发生率分别为 7.7%和 37.7%。相比之下，三个危险因素的患者 LNM 发生率高达 66.7%。在符合 ESD 扩大适应证的 41 例患者中，有 3 例（7.3%）出现 LNM。无 LVI 的小黏膜内病变（<1.0cm）的 12 例患者均未发现 LNM。
结论
在 UD 型 EGC 中，与 LNM 相关的危险因素包括肿瘤大于 2.0cm、黏膜下浸润和 LVI 的存在。对于大小小于 1.0cm 的黏膜内 UD 型 EGC，单独进行 ESD 可能是足够的治疗方法。当内镜切除标本显示比 ESD 内镜诊断时预期的肿瘤更大、黏膜下和 LVI 更大时，应考虑额外的胃切除术和淋巴结清扫术。
Zotero 插件