Yamao T, Shirao K, Ono H, Kondo H, Saito D, Yamaguchi H, Sasako M, Sano T, Ochiai A, Yoshida S
Department of Internal Medicine, National Cancer Center Hospital, Tokyo, Japan.
Cancer. 1996 Feb 15;77(4):602-6. doi: 10.1002/(SICI)1097-0142(19960215)77:4<602::AID-CNCR3>3.0.CO;2-I.
Although regional lymph node metastasis from intramucosal early gastric carcinoma (EGC) is rare, it is very important to clarify the characteristics of patients having lymph nodal metastases in order to determine appropriate therapy.
The authors investigated 1196 patients with solitary intramucosal EGC who underwent resection at the National Cancer Center Hospital in Tokyo, with special reference to lymph node metastases. Eight clinicopathologic factors (age, sex, tumor: size, location, macroscopic type, histologic type, histologic ulceration of the tumor, and lymphatic vessel invasion) were investigated by univariate and multivariate analyses for their possible relationship to lymph node metastasis.
Lymph node metastases were found in 43 patients (3.5%). Univariate analysis revealed that younger age (< 57 years), macroscopic depressed type, larger tumor size (> or= 30 mm), undifferentiated histologic type, histologic ulceration of the carcinoma, and lymphatic vessel invasion had a significant association with regional lymph node metastasis. Multivariate analysis revealed that lymphatic vessel invasion, histologic ulceration of the tumor, and larger size (> or = 30 mm) were independent risk factors for regional lymph node metastasis. The incidence of lymph node metastasis from intramucosal EGC negative for these 3 risk factors was only 0.36% (1 in 277 patients).
Lymphadenectomy is unnecessary for patients with small intramucosal EGC with neither histologic ulceration of the tumor nor lymphatic vessel invasion because the incidence of regional lymph node metastasis is extremely low in those patients. The therapeutic options for such patients would be local resection or endoscopic resection.
尽管黏膜内早期胃癌（EGC）发生区域淋巴结转移的情况罕见，但明确发生淋巴结转移患者的特征对于确定恰当的治疗方法非常重要。
作者调查了在东京国立癌症中心医院接受手术切除的1196例孤立性黏膜内EGC患者，特别关注淋巴结转移情况。通过单因素和多因素分析研究了八个临床病理因素（年龄、性别、肿瘤大小、位置、大体类型、组织学类型、肿瘤组织学溃疡形成以及淋巴管侵犯）与淋巴结转移的可能关系。
43例患者（3.5%）发现有淋巴结转移。单因素分析显示，年龄较轻（<57岁）、大体凹陷型、肿瘤较大（≥30mm）、未分化组织学类型、癌组织学溃疡形成以及淋巴管侵犯与区域淋巴结转移显著相关。多因素分析显示，淋巴管侵犯、肿瘤组织学溃疡形成以及较大尺寸（≥30mm）是区域淋巴结转移的独立危险因素。这三个危险因素均为阴性的黏膜内EGC患者发生淋巴结转移的发生率仅为0.36%（277例患者中有1例）。
对于肿瘤既无组织学溃疡形成也无淋巴管侵犯的小黏膜内EGC患者，无需进行淋巴结清扫，因为这些患者区域淋巴结转移的发生率极低。此类患者的治疗选择可以是局部切除或内镜切除。
