Rates of lymph node metastasis and survival in T1a gastric adenocarcinoma in Western populations.
Rates of lymph node metastasis and survival in T1a gastric adenocarcinoma in Western populations.
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DOI：
10.1016/j.gie.2015.10.039
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发表时间：
2016-06
影响因子：
7.7
通讯作者：
Kim J
中科院分区：
文献类型：
--
作者：
Choi AH;Nelson RA;Merchant SJ;Kim JY;Chao J;Kim J
内窥镜黏膜切除术(EMR)和内窥镜黏膜下剥离术(ESD)在亚洲被广泛接受用于治疗早期胃癌(EGC)。很少有研究研究西方人群中EGC的淋巴转移。我们试图研究异质西方人群中的EGC和LN转移。2002年至2012年，在监测、流行病学和最终结果(SEER)数据库中确定了手术切除的、经组织学证实的AJCC T1a胃腺癌患者。如果患者有IV期疾病，有多原发癌或接受新辅助治疗，则排除这些患者。计算淋巴结转移率，并进行生存分析。在队列中的923名患者中，72名(7.8%)患者在最终病理上至少有一例LN阳性。当按种族分层时，亚洲/太平洋岛民的淋巴结转移率最低(n=17/327；5.2%)，其次是西班牙裔(n=12/171；7.0%)、白人(n=27/278；9.7%)和黑人(n=16/147；10.9%)。IA期疾病以API(93.9%)和西班牙裔(92.4%)患者最高，其次是白人(89.9%)和黑人(87.1%)(p=0.04)。按种族/民族对T1a胃癌患者的生存分析显示，API的5年总生存率最高(API 88%，西班牙裔81%，黑人79%，白人77%；p<；0.01)。美国T1a胃癌的LN转移率高于亚洲报告的比率。T1a胃癌的生存结果因种族而有显著差异，这表明最终的内窥镜治疗可能并不适用于美国的所有患者。
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely accepted in Asia for treatment of early gastric cancer (EGC). Few studies have examined lymph node (LN) metastasis for EGC in Western populations. We sought to examine EGC and LN metastasis in a heterogeneous Western population. Patients with surgically resected, histologically confirmed AJCC T1a gastric adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2002 to 2012. Patients were excluded if they had stage IV disease, had multiple primary cancers, or received neoadjuvant therapy. Rates of LN metastasis were calculated and survival analyses were performed. Of 923 patients in the cohort, 72 (7.8%) patients had at least one positive LN on final pathology. When stratified by race, Asian/Pacific Islanders (APIs) demonstrated the lowest rate of LN metastases (n = 17/327; 5.2%), followed by Hispanics (n = 12/171; 7.0%), whites (n = 27/278; 9.7%), and blacks (n = 16/147; 10.9%). The highest rates of Stage IA disease were observed in API (93.9%) and Hispanic (92.4%) patients, followed by white (89.9%) and black (87.1%) patients (p = 0.04). Survival analysis of T1a gastric cancer patients by race/ethnicity showed 5-year overall survival was highest for API (API 88%, Hispanic 81%, black 79%, and white 77%; p<0.01). The rate of LN metastasis in T1a gastric cancers in the United States is higher than the rates reported in Asia. Survival outcomes in T1a gastric cancers varied significantly by race, suggesting that definitive endoscopic treatment may not be appropriate for all patients in the United States.