Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, Jiangsu Province, China.
World J Surg Oncol. 2021 Jan 21;19(1):20. doi: 10.1186/s12957-021-02130-8.
As a common malignancy, gastric cancer (GC) remains an important threat to human's health. The incidence of synchronous multiple gastric cancer (SMGC) has increased obviously with technical advances of endoscopic and pathological examinations. Several studies have investigated the relationship between SMGC and solitary gastric cancer (SGC). However, little is known about the relationship between early and advanced SMGCs, and the independent risk factors of lymph node metastasis and prognosis in SMGC patients remain unclear.
We retrospectively collected 57 patients diagnosed as SMGC and underwent radical gastrectomies from December 2011 to September 2019. Epidemiological data and clinicopathological characteristics of all patients were recorded. Postoperative follow-up was performed by telephone or outpatient service. Chi-squared test or Fisher's exact test was adopted in analysis of categorical data. Continuous data were analyzed by using unpaired t test. Univariate and multivariate analyses were performed to investigate the independent risk factors of lymph node metastasis and tumor recurrence of SMGC.
There were 45 males and 12 females. The average age was 62.1 years old. There were 20 patients with early SMGC and 37 patients with advanced SMGC. Most of patients (91.2%) had two malignant lesions. Tumor recurrence occurred in 8 patients, among which 7 patients died from recurrence. The rates of total gastrectomy, tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer and nerve invasion, and preoperative CEA level were significantly higher in advanced SMGC patients compared to those with early SMGC. Lymphovascular cancer plug and preoperative CA125 were the independent risk factors of lymph node metastasis in patients with SMGC. Lymph node metastasis, nerve invasion, and preoperative AFP might be the risk factors of tumor recurrence of SMGC, but need further validation.
In patients with SMGC, the presence of tumor size ≥ 2 cm, poorly differentiated type, lymph node metastasis, ulcer, nerve invasion, and relatively high preoperative CEA level might indicate the advanced SMGC. More attention should be paid to lymph node metastasis in SMGC patients with lymphovascular cancer plug and high preoperative CA125. Lymph node metastasis, nerve invasion, and preoperative AFP might be associated with recurrence of SMGC, needing further validation.
胃癌（GC）作为一种常见的恶性肿瘤，仍然严重威胁着人类的健康。随着内镜和病理检查技术的进步，同步多发胃癌（SMGC）的发病率明显升高。已有几项研究探讨了 SMGC 与单发胃癌（SGC）之间的关系。然而，关于早期和晚期 SMGC 之间的关系，以及 SMGC 患者发生淋巴结转移和预后的独立危险因素尚不清楚。
我们回顾性收集了 2011 年 12 月至 2019 年 9 月期间诊断为 SMGC 并接受根治性胃切除术的 57 例患者。记录所有患者的流行病学数据和临床病理特征。通过电话或门诊进行术后随访。采用卡方检验或 Fisher 确切概率法分析分类数据。采用配对 t 检验分析连续数据。采用单因素和多因素分析探讨 SMGC 淋巴结转移和肿瘤复发的独立危险因素。
共 45 例男性，12 例女性。平均年龄为 62.1 岁。20 例患者为早期 SMGC，37 例为晚期 SMGC。大多数患者（91.2%）有两个恶性病变。8 例患者出现肿瘤复发，其中 7 例死于复发。晚期 SMGC 患者的全胃切除术、肿瘤大小≥2cm、低分化型、淋巴结转移、溃疡和神经侵犯、术前 CEA 水平明显高于早期 SMGC 患者。血管淋巴管癌栓和术前 CA125 是 SMGC 患者淋巴结转移的独立危险因素。淋巴结转移、神经侵犯和术前 AFP 可能是 SMGC 肿瘤复发的危险因素，但需要进一步验证。
在 SMGC 患者中，肿瘤大小≥2cm、低分化型、淋巴结转移、溃疡、神经侵犯和术前 CEA 水平较高可能提示为晚期 SMGC。SMGC 患者伴有血管淋巴管癌栓和术前 CA125 升高者应更注意淋巴结转移。淋巴结转移、神经侵犯和术前 AFP 可能与 SMGC 复发相关，需要进一步验证。
