Prognostic value of extracapsular invasion and fibrotic focus in single lymph node metastasis of gastric cancer
Prognostic value of extracapsular invasion and fibrotic focus in single lymph node metastasis of gastric cancer
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DOI：
10.1007/s10120-008-0473-8
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发表时间：
2008-01-01
期刊：
影响因子：
7.4
通讯作者：
Noguchi, Yoshikazu
中科院分区：
文献类型：
--
作者：
Okamoto, Takahide;Tsuburaya, Akira;Noguchi, Yoshikazu
背景。转移性淋巴结的组织学表现是胃癌患者预后的重要指标。本研究选取单发淋巴结转移、无浆膜浸润、无转移至腹膜、肝脏及远端脏器的胃癌患者为研究对象，探讨胃癌早期淋巴结转移的各种病理特征的临床意义。78名符合条件的患者进入了这项研究。这些患者根据一个转移淋巴结的以下组织学特征进行细分：转移的大小（即肿瘤细胞的数量[AT]），增殖模式（PP），结内位置（IL）以及是否存在囊外浸润（ECI）和/或纤维化灶（FF）。研究了临床病理因素、生存率和淋巴结发现之间的关系。AT或PP与任何临床病理因素均无相关性。IL与静脉浸润及原发肿瘤病理特征有显著相关性。ECI和FF在pT2癌中的发生率明显高于pT1癌。尽管OS不受AT、PP或IL的影响，但总生存率（OS）根据侵袭深度、静脉侵入以及是否存在ECI或FF而有显著差异。有和没有ECI的患者的10年总生存率分别为50%和80%，而有和没有FF的患者的10年总生存率分别为50%和79%。多因素分析显示，ECI和FF是预后预后的重要指标。这些结果强烈提示ECI或FF的存在会影响胃癌患者的生存。
Background. Histological findings of metastatic lymph nodes are important prognosticators in patients with gastric cancer. The aim of this study was to clarify the clinical significance of various pathological characteristics of the early phase of lymph node metastasis in patients with gastric cancer, by selecting patients with tumors that had single lymph node metastases, no serosal invasion, and no metastases to the peritoneum, liver, or distant organs.Methods. Seventy-eight patients were eligible and were entered in this study. These patients were subdivided according to the following histological characteristics of the one metastatic lymph node: size of the metastasis (i.e., amount of tumor cells [AT]), proliferating pattern (PP), intranodal location (IL), and the presence or absence of extracapsular invasion (ECI) and/or fibrotic focus (FF). Associations between clinicopathological factors, survival, and the nodal findings were examined.Results. There were no correlations between AT or PP and any clinicopathological factors. IL was significantly correlated with venous invasion and the pathological characteristics of the primary tumor. ECI and FF were observed significantly more frequently in pT2 than in pT1 cancer. Overall survival (OS) differed significantly according to depth of invasion, venous invasion, and the presence or absence of ECI or FF, although OS was not affected by AT, PP, or IL. The 10-year overall survival rates of patients with and without ECI were 50 % and 80 %, respectively, while these rates for patients with and without FF were 50 % and 79 %, respectively. multivariate analysis revealed that ECI and FF were significant prognosticators of survival.Conclusion. These results strongly suggested that the presence of ECI or FF could affect the survival of patients with gastric cancer.