Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer
Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer
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DOI：
10.1055/s-0029-1214758
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发表时间：
2009-06-01
期刊：
影响因子：
9.3
通讯作者：
Nakano, A.
中科院分区：
文献类型：
--
作者：
Kunisaki, C.;Takahashi, M.;Nakano, A.
背景：我们回顾性评估了低分化早期胃癌（低分化管状腺癌、印戒细胞癌、粘液腺癌）淋巴结转移的预测因素，以探讨低分化早期胃癌内镜切除的可能性。方法：共573例组织学低分化型早期胃癌患者（269例粘膜层，304例粘膜下层）接受了内镜下切除术。根治性胃切除术，被纳入本研究。通过单因素和logistic回归分析评估淋巴结转移的危险因素。结果：74例患者（12.9%）出现淋巴结转移（粘膜癌6例，粘膜下癌68例）。通过单变量分析，淋巴结转移的危险因素包括淋巴管侵犯（LVI）（存在）、侵犯深度（粘膜下层）、肿瘤直径I（> 20 mm）、溃疡或溃疡疤痕（存在）和组织学类型（粘液腺癌）。多因素分析显示，淋巴结转移的危险因素为LVI、浸润深度和肿瘤直径。在粘膜癌中，无论是否有 LVI，小于 20 mm 的肿瘤淋巴结转移的发生率为 0%，而在 20 mm 或更大且无 LVI 的肿瘤中，淋巴结转移的发生率为 1.7%。在粘膜下癌中，小于20mm且无LVI的肿瘤淋巴结转移的发生率为2.4%。结论：组织学低分化型粘膜胃癌小于20mm且无LVI可能是内镜切除的候选者。这一结果应该在对许多患者进行的更大规模的研究中得到证实。
Background: We retrospectively evaluated the predictive factors for lymph node metastasis in poorly differentiated early gastric cancer (poorly differentiated tubular adenocarcinoma, signetring cell carcinoma, mucinous adenocarcinoma) in order to examine the possibility of endoscopic resection for poorly differentiated early gastric cancer.Methods: A total of 573 patients with histologically poorly differentiated type early gastric cancer (269 mucosal and 304 submucosal), who had undergone curative gastrectomy, were enrolled in this study. Risk factors for lymph node metastasis were evaluated by univariate and logistic regression analysis.Results: Lymph node metastasis was observed in 74 patients (12.9%) (6 with mucosal cancer and 68 with submucosal cancer). By univariate analysis risk factors for lymph node metastasis were lymphovascular invasion (LVI) (presence), depth of invasion (submucosa), and tumor diameter I(> 20 mm), ulcer or ulcer scar (presence), and histological type (mucinous adenocarcinoma). By multivariate analysis, risk factors for lymph node metastasis were LVI, depth of invasion, and tumor diameter. in mucosal cancers, the incidence of lymph node metastasis was 0% irrespective of LVI in tumors smaller than 20 mm, and 1.7% in tumors 20 mm or larger without LVI. In submucosal cancers, the incidence of lymph node metastasis was 2.4% in tumors smaller than 20 mm without LVI.Conclusions: A histologically poorly differentiated type mucosal gastric cancer measuring less than 20 mm and without LVI may be a candidate for endoscopic resection. This result should be confirmed in a larger study with many patients.