Department of General Surgery and Medical-Surgical Specialty, University of Catania, Catania, Italy.
Department of Surgery, Ospedale Maggiore di Lodi, ASST di Lodi, Lodi, Italy.
PLoS One. 2020 Apr 29;15(4):e0232429. doi: 10.1371/journal.pone.0232429. eCollection 2020.
The use of endoscopic techniques to cure small sized, well differentiated early gastric cancer has been adopted worldwide. In the Eastern world, endoscopic resection is being increasingly utilized to treat small undifferentiated early gastric cancer according to the extended criteria proposed by the Japanese Gastric Cancer Associations. However, studies in the Western world reported in these tumors a rate of nodal metastasis ranging between 5% and 20%, that is higher of those observed in Eastern counterparts. A tool to predict the risk of nodal dissemination would be of great use to guide treatment toward endoscopic resection. In our study, we propose E-cadherin expression as a biological factor to predict lymph node involvement. We retrospectively reviewed the E-cadherin (E-cad) expression profile of all histological specimens of undifferentiated early gastric cancer from two Oncologic Departments and compared it with several tumor characteristics. A total of 39 patients with early gastric cancer met the inclusion criteria, of which 16 (41%) pT1a, and 23 (58.9%) pT1b SM1. Thirty-two patients (82%) underwent subtotal gastrectomy, whereas total gastrectomy was performed in only seven cases (17.9%). Patients were divided into two groups: low E-cad expression (E-cad 0/1+, 10 patients) and high E-cad expression (E-cad 2+/3+, 29 patients) according to the immunohistochemical assay (ICH). On univariate analysis, we found an association between low E-cad expression and low grading tumor (p = 0.019), pure undifferentiated histotype (PU-type) (p = 0.014), and lymph node involvement (N+) (p < 0.001). The association between low E-cad expression and lymph node metastasis was confirmed by multivariate analysis (OR = 14.5, 95% CI 3.46-60.76, p < 0.001). The loss of expression of E-cad may be a simple biological factor to predict lymph nodes metastasis in patients with undifferentiated early gastric cancer. Additional larger prospective studies are necessary to confirm these findings.
内镜技术已被广泛应用于治疗直径较小、分化良好的早期胃癌。在东亚，根据日本胃癌协会提出的扩展标准，内镜下切除被越来越多地应用于治疗直径较小、未分化的早期胃癌。然而，在西方世界的研究中报道，这些肿瘤的淋巴结转移率在 5%至 20%之间，高于东亚的报道。一个预测淋巴结转移风险的工具将极大地有助于指导治疗方法向内镜下切除的方向发展。在我们的研究中，我们提出了 E-钙黏蛋白（E-cadherin）的表达作为预测淋巴结受累的生物学因素。我们回顾性地分析了来自两个肿瘤学部门的所有未分化早期胃癌组织学标本的 E-cadherin（E-cad）表达谱，并将其与几种肿瘤特征进行了比较。共有 39 名符合纳入标准的早期胃癌患者，其中 16 例（41%）为 pT1a，23 例（58.9%）为 pT1b SM1。32 例（82%）患者行胃大部切除术，仅 7 例（17.9%）行全胃切除术。根据免疫组织化学检测（ICH），患者被分为两组：低 E-cad 表达组（E-cad0/1+，10 例）和高 E-cad 表达组（E-cad2+/3+，29 例）。单因素分析发现，低 E-cad 表达与肿瘤分级低（p=0.019）、纯未分化组织学类型（PU 型）（p=0.014）和淋巴结受累（N+）（p<0.001）有关。多因素分析证实了低 E-cad 表达与淋巴结转移之间的关联（OR=14.5，95%CI3.46-60.76，p<0.001）。E-cad 表达缺失可能是预测未分化早期胃癌患者淋巴结转移的一个简单的生物学因素。需要进一步的更大规模的前瞻性研究来证实这些发现。
