Risk factors for lymph node metastasis of submucosal invasive differentiated type gastric carcinoma: clinical significance of histological heterogeneity
Risk factors for lymph node metastasis of submucosal invasive differentiated type gastric carcinoma: clinical significance of histological heterogeneity
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DOI：
10.1007/s005350170028
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发表时间：
2001-10-01
影响因子：
6.3
通讯作者：
Shimoda, T
中科院分区：
文献类型：
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作者：
Mita, T;Shimoda, T
背景。组织分化型黏膜下浸润性胃癌(Sm-ca)的内窥镜切除已被期待。然而，治疗标准仍然存在争议。本研究的目的是阐明分化型Sm-ca的组织学特征与淋巴结转移的关系。方法：研究方法。对35例结节阳性分化型Sm-ca和221例结节阴性分化型Sm-ca的临床病理特征进行多因素Logistic回归分析。为了阐明分化的Sm-ca的转移行为，我们检测了粘液组织化学表达和免疫组织化学染色，使用Ki-67、P53和c-erbB2。结果。组织学异质性(合并分化型、低分化成分)的分化型Sm-ca的淋巴结转移率显著高于无组织异质性者(27%vs7%；P<；0.001)。多因素分析显示淋巴管侵犯是淋巴结转移最显著的决定因素(优势比为8.68)。其次是组织学异质性(优势比，3.88)，其次是乳头状腺癌(优势比，3.28)和粘膜下侵袭程度(优势比，2.34)。结节阳性分化型Sm-ca的Ki-67标记指数均值高于结节阴性分化型Sm-ca(47%比39%；P<；0.05)。结论。当考虑将内窥镜手术扩展到分化型Sm-ca时，这种治疗技术应该局限于组织学上没有异质性的分化型Sm-ca。Ki-67标记指数为鉴别高危淋巴结转移患者提供了有用的信息。
Background The. use of endoscopic resection for submucosal invasive gastric carcinoma (Sm-ca) with histologically differentiated type has been expected. However, the treatment criteria remain controversial. The purpose of this study was to clarify the relationship between lymph node metastasis and the histologic features of differentiated Sm-ca. Methods. The clinicopathologic features of 35 patients with node-positive differentiated Sm-ca were compared with those of 221 patients with node-negative differentiated Sm-ca by multivariate: analysis with logistic regression. To clarify the metastatic behavior of differentiated Sm-ca, we examined mucin-histochemical expression and immunohistochemical staining, using Ki-67, p53, and c-erbB2. Results. The rate of lymph node metastasis was significantly higher in differentiated Sm-ca with histological heterogeneity (combined differentiated type, with poorly differentiated component) than in that without histological heterogeneity (27% vs 7%; P < 0.001). Multivariate analysis revealed that lymphatic vessel invasion was the most significant determinant (odds ratio, 8.68) for lymph node metastasis. Histological heterogeneity (odds ratio, 3.88) was next, followed by papillary adenocarcinoma (odds ratio, 3.28), and submucosal invasion level (odds ratio, 2.34). The mean value of the Ki-67 labeling index for node-positive differentiated Sm-ca was higher than that of node-negative differentiated Sm-ca (47% vs 39%; P < 0.05). Conclusions. When the extension of endoscopic surgery to differentiated Sm-ca is considered, this therapeutic technique should be limited to the differentiated type of Sm-ca without histological heterogeneity. The Ki-67 labeling index provides useful information for identifying those patients with a high risk of lymph node metastasis.