Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.
Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers.
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DOI：
10.1007/pl00011720
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发表时间：
2000-12-01
期刊：
影响因子：
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通讯作者：
Kato, Yo
中科院分区：
文献类型：
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作者：
Gotoda, Takuji;Yanagisawa, Akio;Kato, Yo
背景：淋巴结转移是早期胃癌最重要的预后因素。D2胃切除术一直是金标准治疗。在日本，内镜粘膜切除术的严格标准已被广泛接受。有一些试验旨在扩大适应症的局部治疗，虽然还没有一个全面的审查风险LNM与病变的EGC.METHODS：我们调查了5265例患者进行了胃切除术淋巴结清扫EGC在国家癌症中心医院和癌症研究所医院。9个临床病理因素进行了评估，他们可能与LNM.RESULTS：没有1230分化良好的粘膜内癌直径小于30毫米，无论溃疡的发现，与转移（95%置信区间[CI]，0-0.3%）。无论肿瘤大小如何，929个无溃疡的病变均与淋巴结转移无关（95% CI，0-0.4%）。与粘膜内癌的结果相似，对于粘膜下病变，肿瘤大小大于30 mm与血管受累之间存在显著相关性，LNM风险增加。没有145分化腺癌直径小于30毫米，没有淋巴或静脉渗透与淋巴结转移，只要病变侵入不到500米到粘膜下层（95%CI，0-2.5%）。结论：根据我们的大系列的情况下，我们已经能够澄清与EGC相关的风险，并提出扩大局部治疗的标准。然而，切除标本的准确组织学评价是必不可少的，以避免复发的EGCs，应该治愈。
BACKGROUND: The presence of lymph node metastasis (LNM) is the most important prognostic factor for patients with early gastric cancer (EGC). A D2 gastrectomy has been the gold standard treatment. Strict criteria for endoscopic mucosal resection have been widely accepted in Japan. There are some trials aimed at expanding the indications for local treatment, although there has not been a comprehensive review of the risk of LNM with the lesions of EGC.METHODS: We investigated 5265 patients who had undergone gastrectomy with lymph node dissection for EGC at the National Cancer Center Hospital and the Cancer Institute Hospital. Nine clinicopathological factors were assessed for their possible association with LNM.RESULTS: None of the 1230 well differentiated intramucosal cancers of less than 30 mm diameter regardless of ulceration findings, were associated with metastases (95% confidence interval [CI], 0-0.3%). None of the 929 lesions without ulceration were associated with nodal metastases (95% CI, 0-0.4%) regardless of tumor size. Similarly to findings for intramucosal cancers, for submucosal lesions, there was a significant correlation between tumor size larger than 30 mm and lymphatic-vascular involvement with an increased risk of LNM. None of the 145 differentiated adenocarcinomas of less than 30-mm-diameter without lymphatic or venous permeation were associated with LNM, provided that the lesion had invaded less than 500 &mgr;m into the submucosa (95% CI, 0-2.5%).CONCLUSION: Based on our large series of cases, we have been able to clarify the risks associated with EGC and to propose expansion of the criteria for local treatment. However, accurate histological evaluation of the resected specimens is essential to avoid recurrence for such EGCs that should be cured.