Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
J Surg Res. 2023 Feb;282:160-167. doi: 10.1016/j.jss.2022.09.013. Epub 2022 Oct 25.
The treatment regimen for early gastric cancer (EGC) with mixed histologic type remains controversial. We aimed to clarify the relationship between mixed histologic type and lymph node metastasis (LNM) in EGC, with emphasis on submucosal invasive EGC.
We collected data on 730 consecutive EGC patients at Nanjing Drum Tower hospital between June 2010 and May 2019. Risk factors of LNM and overall survival were analyzed to compare the prognostic differences between different histologic types.
Mixed-type EGC patients had higher LNM rates than differentiated-type patients (29.2 % versus 10.6 %, P < 0.001), while no significant difference was found between mixed-type and undifferentiated-type EGC patients (29.2% versus 24.0%, P = 0.225). Multivariate analyses identified tumor location (cardiac and bottom versus antrum), larger tumor size, submucosal invasion, histologic differentiation (undifferentiated-type, mixed-type versus differentiated-type), and lymphovascular invasion as independent risk factors for LNM in EGC patients. Subgroup analysis further elucidated that mixed histologic type was associated with LNM in submucosa invasive EGC, but not in mucosa-confined EGC. There was no statistical significance in overall survival and disease-specific survival of submucosal invasive EGC patients who underwent radical gastrectomy with lymphadenectomy between different histologic types (P = 0.151).
Mixed histologic type may be an independent risk factor for LNM in submucosal invasive EGC. Curative resection with lymphadenectomy should be considered the appropriate treatment for submucosal invasive EGC with mixed histologic type.
混合组织学类型早期胃癌（EGC）的治疗方案仍存在争议。我们旨在阐明混合组织学类型与 EGC 淋巴结转移（LNM）之间的关系，重点关注黏膜下浸润性 EGC。
我们收集了 2010 年 6 月至 2019 年 5 月期间在南京鼓楼医院连续收治的 730 例 EGC 患者的数据。分析了 LNM 和总生存的危险因素，以比较不同组织学类型之间的预后差异。
混合组织学类型 EGC 患者的 LNM 率高于分化型患者（29.2%比 10.6%，P<0.001），但混合组织学类型与未分化型 EGC 患者之间无显著差异（29.2%比 24.0%，P=0.225）。多因素分析确定肿瘤位置（贲门和底部与胃窦）、肿瘤较大、黏膜下浸润、组织学分化（未分化型、混合型与分化型）和淋巴管浸润是 EGC 患者发生 LNM 的独立危险因素。亚组分析进一步阐明，混合组织学类型与黏膜下浸润性 EGC 中的 LNM 相关，但与黏膜内 EGC 无关。不同组织学类型的黏膜下浸润性 EGC 患者行根治性胃切除加淋巴结清扫术后，总生存和疾病特异性生存无统计学意义（P=0.151）。
混合组织学类型可能是黏膜下浸润性 EGC 中 LNM 的独立危险因素。对于混合组织学类型的黏膜下浸润性 EGC，应考虑根治性切除加淋巴结清扫术作为适当的治疗方法。
