Departments of Gastroenterology.
Critical Care Medicine.
Am J Surg Pathol. 2020 Jul;44(7):934-942. doi: 10.1097/PAS.0000000000001460.
The aim of this study was to investigate predictors of lymph node metastasis (LNM) in early gastric signet-ring cell carcinoma (SRCC) and determine clinicopathologic and prognostic differences of different histologic subtypes. We retrospectively analyzed 13,661 gastric cancer patients; 231 were eligible for inclusion. Data for clinical, endoscopic, and histopathologic characteristics and prognoses were collected. Patients were followed up regarding postresection survival; overall and disease-specific survival rates were estimated by the Kaplan-Meier method with a log-rank test, and prognostic factors were evaluated by Cox regression. LNM incidence in early SRCC was 16.0% (37/231) overall: 6.9% (8/116) and 25.2% (29/115) in patients with pure and mixed SRCC, respectively. Univariate and multivariate analyses revealed SM2 invasion (odds ratio [OR]=5.070, P=0.003), lymphovascular invasion (LVI) (OR=14.876, P<0.001), pathologic pattern of mixed SRCC (OR=3.226, P=0.026), ulcer presence (OR=3.340, P=0.019) and lesion size over 20 mm (OR=2.823, P=0.015) as independent risk factors for LNM. Compared with pure SRCC, the mixed subtype was associated with older age, larger lesion size, higher LVI frequency, more frequent perineural invasion, and most importantly, higher LNM incidence. Patients with pure SRCC showed significantly longer overall survival (P=0.004) and disease-specific survival (P=0.002) than mixed SRCC patients. Pathologic subtype (hazard ratio [HR]=3.682; P=0.047), age (HR=5.246; P=0.001), SM1 invasion (HR=6.192; P=0.023), SM2 invasion (HR=7.529; P=0.021) and LNM (HR=5.352; P<0.001) were independent prognostic factors. Independent risk factors for LNM in early gastric SRCC were SM2 invasion, LVI, pathologic pattern, ulcer presence and lesion size over 20 mm. Early SRCC should be further classified by the purity of the SRC component.
本研究旨在探讨早期胃印戒细胞癌（SRCC）淋巴结转移（LNM）的预测因素，并确定不同组织学亚型的临床病理和预后差异。我们回顾性分析了 13661 例胃癌患者，其中 231 例符合纳入标准。收集了临床、内镜和组织病理学特征及预后数据。对患者进行术后生存随访，采用 Kaplan-Meier 法和对数秩检验估计总生存率和疾病特异性生存率，采用 Cox 回归评估预后因素。早期 SRCC 的 LNM 发生率为 16.0%（231 例中有 37 例）：纯 SRCC 为 6.9%（116 例中有 8 例），混合 SRCC 为 25.2%（115 例中有 29 例）。单因素和多因素分析显示，SM2 浸润（比值比[OR] = 5.070，P = 0.003）、淋巴管浸润（OR = 14.876，P<0.001）、混合 SRCC 的病理模式（OR = 3.226，P = 0.026）、溃疡存在（OR = 3.340，P = 0.019）和病变大小超过 20 mm（OR = 2.823，P = 0.015）是 LNM 的独立危险因素。与纯 SRCC 相比，混合亚型与年龄较大、病变较大、LVI 频率较高、更频繁的神经周围侵犯有关，最重要的是，LNM 发生率更高。纯 SRCC 患者的总生存率（P = 0.004）和疾病特异性生存率（P = 0.002）明显长于混合 SRCC 患者。病理亚型（风险比[HR] = 3.682；P = 0.047）、年龄（HR = 5.246；P = 0.001）、SM1 浸润（HR = 6.192；P = 0.023）、SM2 浸润（HR = 7.529；P = 0.021）和 LNM（HR = 5.352；P<0.001）是独立的预后因素。早期胃 SRCC 的 LNM 独立危险因素为 SM2 浸润、LVI、病理模式、溃疡存在和病变大小超过 20 mm。早期胃 SRCC 应进一步根据 SRC 成分的纯度进行分类。
