Ⅰ期胃癌的临床病理特征：大体与镜下表现比较

Clinicopathological characteristics of stage 1 gastric cancer: comparison of macroscopic and microscopic findings.

作者信息

Baba H, Ohshiro T, Yamamoto M, Endo K, Adachi E, Kakeji Y, Kohnoe S, Maehara Y, Sugimachi K

机构信息

Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

出版信息

Hepatogastroenterology. 1997 Mar-Apr;44(14):554-8.

PMID:9164536

Abstract

BACKGROUND/AIMS: Laparoscopic surgery or endoscopic mucosal resection for early stages of gastric cancer have been introduced recently in many regions. In such cases, a precise diagnosis is needed prior to treatment, since understaging of gastric cancer may lead to treatment failure and impairment of curability and prognosis. The clinicopathological features of understaged cases in macroscopic Stage 1 gastric cancer have not been clarified yet.

MATERIAL AND METHODS

We examined 435 patients with intra-operative findings of macroscopic Stage 1 gastric cancer and compared clinicopathological features of 354 patients (Group A) with both macroscopic and histological stage 1 cancer and 81 patients (Group B) with macroscopic Stage 1 but histologically proven to be more advanced cancer.

RESULTS

Among 435 patients with macroscopic Stage 1, there were 81 (18.6%) with histologically more advanced stages (44 of stage 2, 34 of stage 3, and 3 of stage 4). There were no statistical differences in age, sex, operative procedure, and extend of lymph node dissection between the groups. Carcinomas in the 81 Group B patients tended to have larger tumors (> 4 cm), located in the middle third and along the lesser curvature of the stomach, appeared to be Borrmann V type (unclassified type) and were histologically more often associated with undifferentiated type, INF-gamma, lymphovascular invasion, lymph node metastasis, and invasion into a layer deeper than submucosa, all of which resulted in significantly poorer prognosis.

CONCLUSIONS

Pre-operative and intra-operative assessment of the stage for gastric cancer was not always accurate enough and about one fifth cases with macroscopic Stage 1 gastric cancer were understaged. Thus, we recommend gastrectomy plus radical lymphadenectomy (at least D2) for the treatment of choice, from the points of view of curability and prognosis when gastric carcinoma is associated with the above mentioned characteristics.

摘要

背景/目的：腹腔镜手术或内镜黏膜切除术治疗早期胃癌最近已在许多地区开展。在此类病例中，治疗前需要精确诊断，因为胃癌分期不足可能导致治疗失败以及治愈率和预后受损。肉眼观察为1期胃癌但分期不足病例的临床病理特征尚未明确。

材料与方法

我们检查了435例术中发现为肉眼观察1期胃癌的患者，并比较了354例肉眼和组织学均为1期癌症患者（A组）与81例肉眼观察为1期但组织学证实为更进展期癌症患者（B组）的临床病理特征。

结果

在435例肉眼观察为1期的患者中，有81例（18.6%）组织学分期更晚（44例为2期，34例为3期，3例为4期）。两组在年龄、性别、手术方式和淋巴结清扫范围方面无统计学差异。B组的81例患者的癌灶往往肿瘤更大（>4cm），位于胃中1/3且沿胃小弯，外观为Borrmann V型（未分类型），组织学上更常与未分化型、INF-γ、淋巴管浸润、淋巴结转移以及浸润至黏膜下层以下层次相关，所有这些均导致预后明显更差。