Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity
Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity
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DOI：
10.1007/s10120-014-0378-7
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发表时间：
2015-07-01
期刊：
影响因子：
7.4
通讯作者：
Kim, Jae J.
中科院分区：
文献类型：
--
作者：
Min, Byung-Hoon;Kim, Kyoung-Mee;Kim, Jae J.
对于分化型为主的早期胃癌（EGC）与未分化成分（MUC-EGC）混合的内镜粘膜下剥离术（ESD）后的长期临床结果尚不清楚。因此，ESD对MUC-EGC的作用和适当的适应症仍有待评估。2007年至2011年间，连续1,527名患者中的1,577个分化型EGC病变[1,408个纯分化型(PuD)-EGC和169个MUC-EGC]接受了ESD治疗。 ESD后，MUC-EGC的管理方式与PuD-EGC相同。将MUC-EGC与PuD-EGC进行ESD后的临床病理特征和远期结局进行比较。MUC-EGC的整块切除率和整块R0切除率分别为94.1%和81.7%。与 PuD-EGC 相比，MUC-EGC 与较大的肿瘤尺寸、更频繁的粘膜下浸润和淋巴管浸润显着相关。尽管MUC-EGC具有这些侵袭性特征，但如果MUC-EGC满足绝对或扩大适应症肿瘤的治愈性内镜切除（ER）标准，则在ESD后随访期间不会发生淋巴结转移或胃外复发。 4例符合ER治愈标准的MUC-EGC病例在ESD后行追加根治性胃切除术，无一例出现淋巴结转移。在中位 48 个月的随访期间，满足绝对或扩大适应症肿瘤的治疗 ER 标准（3 年生存率、100% 和 100%）的 MUC-EGC 的总生存率与 PuD-EGC 相当。ESD 后的长期结果有利于满足绝对或扩大适应症肿瘤的治疗 ER 标准的 MUC-EGC。因此，ESD 可能作为这些病例的一种有前景的治疗选择。
Long-term clinical outcomes after endoscopic submucosal dissection (ESD) is unclear for differentiated-type-predominant early gastric cancer (EGC) mixed with undifferentiated component (MUC-EGC). Therefore, the role and appropriate indication of ESD for MUC-EGC remain to be evaluated.Between 2007 and 2011, 1,577 differentiated-type EGC lesions [1,408 pure differentiated-type (PuD)-EGCs and 169 MUC-EGCs] in 1,527 consecutive patients were treated by ESD. After ESD, MUC-EGC was managed in the same way as PuD-EGC. The clinicopathological features and long-term outcomes after ESD of MUC-EGC were compared with those of PuD-EGC.En bloc resection and en bloc with R0 resection rates in MUC-EGC cases were 94.1 % and 81.7 %, respectively. MUC-EGC was significantly associated with larger tumor size, more frequent submucosal invasion, and lymphovascular invasion compared to PuD-EGC. Despite these aggressive features of MUC-EGC, no lymph node metastasis or extragastric recurrence occurred during follow-up after ESD if MUC-EGC met the curative endoscopic resection (ER) criteria for tumors of absolute or expanded indications. Four MUC-EGC cases meeting the curative ER criteria underwent additional radical gastrectomy after ESD, and no case showed lymph node metastasis. During a median 48 months of follow-up, overall survival rates for MUC-EGC meeting the curative ER criteria for tumors of absolute or expanded indications (3-year survival rates, 100 % and 100 %) were comparable to those of PuD-EGC.Long-term outcomes after ESD were favorable for MUC-EGCs meeting the curative ER criteria for tumors of absolute or expanded indications. Therefore, ESD may be used as a promising treatment option for these cases.