Zou Yi, Wu Long, Yang Yubin, Shen Xin, Zhu Chunpeng
Department of Pathology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
Department of Pathology, Union Hospital of Fujian Medical University, Fuzhou 350001, China.
Ann Transl Med. 2020 Mar;8(6):360. doi: 10.21037/atm.2020.02.42.
Early gastric cancer (EGC) with undifferentiated component (UDC) is a more aggressive entity, where the significance of preoperative data to tumor invasion and lymph node metastasis (LNM) remains unclarified.
A total of 5,020 GC patients undergoing radical gastrectomy in three centers were reviewed, of which, EGC with UDC in preoperative biopsy specimens were enrolled. The histology of biopsy and surgical specimens was graded according to the proportion of UDC and signet ring cells (SRCs). Risk factors of tumor invasion and LNM were evaluated with histological, clinical and demographic data.
Lower body mass index (BMI), melena and larger tumor size were the independent preoperative risk factors of both LNM and LVI, while ulcerative lesion (UL) and the lower third stomach were only correlated with LNM. No relevance was found between the histological features of biopsy specimens and LNM, but SRC or >50% UDC lowered the risk of lymphovascular invasion (LVI) and/or submucosal (SM) invasion. When surgical data (depth of invasion and LVI included) were added, lower BMI, melena and the lower third stomach were still the independent preoperative risk factors of LNM, and LVI, SRC and SM invasion also showed relevance to LNM. The performance of predictive models using pre- or postoperative histological data was comparable.
The preoperative data were significantly relevant to tumor invasion and LNM, showing comparable risk strength with surgical specimens in histology.
伴有未分化成分（UDC）的早期胃癌（EGC）是一种侵袭性更强的实体，术前数据对肿瘤侵袭和淋巴结转移（LNM）的意义仍不明确。
回顾了三个中心共5020例行根治性胃切除术的胃癌患者，其中纳入术前活检标本中有UDC的EGC患者。根据UDC和印戒细胞（SRC）的比例对活检和手术标本的组织学进行分级。利用组织学、临床和人口统计学数据评估肿瘤侵袭和LNM的危险因素。
较低的体重指数（BMI）、黑便和较大的肿瘤大小是LNM和淋巴管侵犯（LVI）的独立术前危险因素，而溃疡性病变（UL）和胃下1/3仅与LNM相关。活检标本的组织学特征与LNM之间未发现相关性，但SRC或UDC>50%可降低淋巴管侵犯（LVI）和/或黏膜下（SM）侵犯的风险。当加入手术数据（包括侵袭深度和LVI）时，较低的BMI、黑便和胃下1/3仍是LNM的独立术前危险因素，LVI、SRC和SM侵犯也与LNM相关。使用术前或术后组织学数据的预测模型的性能相当。
术前数据与肿瘤侵袭和LNM显著相关，在组织学上与手术标本显示出相当的风险强度。
