Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Gut Liver. 2021 Jan 15;15(1):44-52. doi: 10.5009/gnl19328.
BACKGROUND/AIMS: Papillary gastric cancer (GC) is classified as differentiated adenocarcinoma, together with well-differentiated (WD) and moderately differentiated (MD) adenocarcinoma. This study evaluated the risk of lymph node metastasis (LNM) in submucosal (SM) invasive papillary GC compared with other differentiated early GC types.
This retrospective study involved three tertiary hospitals and enrolled 1,798 lesions with differentiated SM invasive GC treated with curative gastrectomy between March 2001 and December 2012. All pathology slides were reviewed, and clinicopathologic findings associated with LNM, including tumor size, location, gross type, ulceration, depth and width of SM invasion, and lymphovascular invasion (LVI), were analyzed.
The proportion of SM papillary GC was 2.8% (n=51). SM papillary GC was associated with larger tumor size and deeper and wider SM invasion than other differentiated GC types. LNM was significantly higher in the papillary type than in the MD and WD types. LNM was found in 27.5% of SM papillary GC patients (WD: 9.0%, MD: 21.2%). LVI was the only significant risk factor for LNM in SM papillary GC. The depth or width of SM invasion was not associated with LNM in papillary GC. Lower third location or elevated gross appearance was significantly associated with LVI.
SM papillary GC had the highest LNM rate, with features different from those of other differentiated SM invasive GCs. The treatment strategy for SM papillary GC should be carefully approached, especially for lesions located in the lower third or of the elevated gross type.
背景/目的：胃的黏膜内浸润型乳头状腺癌被归类为分化型腺癌，与高分化腺癌和中分化腺癌一起分类。本研究评估了黏膜下（SM）浸润性乳头状胃癌与其他分化型早期胃癌类型相比发生淋巴结转移（LNM）的风险。
本回顾性研究涉及三家三级医院，共纳入 2001 年 3 月至 2012 年 12 月期间接受根治性胃切除术治疗的分化型 SM 浸润性 GC 患者 1798 例。所有病理切片均经复习，分析与 LNM 相关的临床病理发现，包括肿瘤大小、位置、大体类型、溃疡、SM 浸润深度和宽度以及淋巴管浸润（LVI）。
SM 乳头状 GC 的比例为 2.8%（n=51）。SM 乳头状 GC 与其他分化型 GC 类型相比，肿瘤更大，SM 浸润更深、更宽。乳头状型 LNM 明显高于 MD 型和 WD 型。SM 乳头状 GC 患者中 LNM 发生率为 27.5%（WD：9.0%，MD：21.2%）。LVI 是 SM 乳头状 GC 发生 LNM 的唯一显著危险因素。SM 浸润型乳头状 GC 的浸润深度或宽度与 LNM 无关。第三低位或隆起型大体外观与 LVI 显著相关。
SM 乳头状 GC 的 LNM 发生率最高，其特征与其他分化型 SM 浸润性 GC 不同。SM 乳头状 GC 的治疗策略应谨慎，特别是对于第三低位或隆起型大体外观的病变。
