Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer
Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer
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DOI：
10.1007/s10120-009-0515-x
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发表时间：
2009-10-01
期刊：
影响因子：
7.4
通讯作者：
Yamaguchi, Toshiharu
中科院分区：
文献类型：
--
作者：
Hirasawa, Toshiaki;Gotoda, Takuji;Yamaguchi, Toshiharu
内镜切除术（ER）已被接受为早期胃癌（EGC）患者的微创治疗，这些患者的淋巴结转移风险可忽略不计。已经确定了分化型EGC中哪些病变的淋巴结转移风险可以忽略不计，并且正在对这些病变进行ER。相比之下，没有达成共识，在未分化型（UD型）EGC病变的淋巴结转移的风险可以忽略不计，也没有ER的UD型EGCbeen established.We调查了3843例患者谁经历了胃切除术与淋巴结清扫孤立UD型EGC在癌症研究所医院，东京，国立癌症中心医院，东京。在3843例患者中，2163例（56.3%）为粘膜内癌，1680例（43.7%）为粘膜下浸润癌。只有105例（4.9%）粘膜内癌和399例（23.8%）粘膜下浸润癌与淋巴结转移有关。多因素分析显示，肿瘤直径≥ 21 mm、毛细血管受累、黏膜下浸润是淋巴结转移的独立危险因素（P < 0.001）。310例大小小于或等于20 mm且无淋巴-血管毛细血管受累和溃疡发现的粘膜内癌中无一与淋巴结转移相关（95%置信区间，0-0.96%）。大小小于或等于20 mm且无淋巴-血管毛细血管受累和溃疡发现的UD型粘膜内EGC淋巴结转移风险可忽略不计。我们建议在这种情况下可以考虑ER。
Endoscopic resection (ER) has been accepted as minimally invasive treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. It has already been determined which lesions in differentiated-type EGC present a negligible risk of lymph node metastasis, and ER is being performed for these lesions. In contrast, no consensus has been reached on which lesions in undifferentiated-type (UD-type) EGC present a negligible risk for lymph node metastasis, nor have indications for ER for UD-type EGC been established.We investigated 3843 patients who had undergone gastrectomy with lymph node dissection for solitary UD-type EGC at the Cancer Institute Hospital, Tokyo, and the National Cancer Center Hospital, Tokyo. Seven clinicopathological factors were assessed for their possible association with lymph node metastasis.Of the 3843 patients, 2163 (56.3%) had intramucosal cancers and 1680 (43.7%) had submucosal invasive cancers. Only 105 (4.9%) intramucosal cancers compared with 399 (23.8%) submucosal invasive cancers were associated with lymph node metastases. By multivariate analysis, tumor size 21 mm or more, lymphatic-vascular capillary involvement, and submucosal penetration were independent risk factors for lymph node metastasis (P < 0.001, respectively). None of the 310 intramucosal cancers 20 mm or less in size without lymphatic- vascular capillary involvement and ulcerative findings was associated with lymph node metastases (95% confidence interval, 0-0.96%).UD-type intramucosal EGC 20 mm or less in size without lymphatic-vascular capillary involvement and ulcerative findings presents a negligible risk of lymph node metastasis. We propose that in this circumstance ER could be considered.