Clinicopathological Features and Prognosis of Mixed-Type T1a Gastric Cancer Based on Lauren's Classification
Clinicopathological Features and Prognosis of Mixed-Type T1a Gastric Cancer Based on Lauren's Classification
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DOI：
10.1245/s10434-016-5549-9
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发表时间：
2016-12-01
影响因子：
3.7
通讯作者：
Kim, Sung
中科院分区：
文献类型：
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作者：
Pyo, Jeung Hui;Ahn, Soomin;Kim, Sung
背景最近的研究报告说，混合型（MT）胃癌，根据劳伦的分类，表现出侵略性行为。然而，早期胃癌的行为尚不清楚。在这项研究中，我们讨论了粘膜局限型MT胃癌，根据劳伦的分类，对淋巴结转移（LNM）和长期预后的影响。在2000年1月至2012年12月接受胃癌胃切除术的患者中，3170例患有粘膜局限性胃癌。根据Lauren的分类，1449例（45.7%）、1528例（48.2%）和193例（6.1%）患者分别患有肠型（IT）、弥漫型（DT）和MT癌。此外，MT癌患者在组织学上分为IT为主的MT（3.0%）和DT为主的MT（2.5%）组。分析比较两组患者的临床病理特征、淋巴结转移发生率、总生存率和无复发生存率。临床病理特征显示，与IT或DT癌相比，粘膜局限型MT胃癌体积更大，浸润更深，淋巴管浸润更频繁。MT病变的LNM（4.7%）与DT病变的LNM（4.8%）相似，多因素Logistic回归分析表明Lauren分类是LNM的显著预测因素（P < 0.001）。然而，MT病变患者的总生存率和无复发生存率无显著差异（P = 0.506和0.359）。因此，在粘膜局限性胃癌患者中，根据Lauren分类，MT癌患者具有侵袭性临床特征和LNM风险。因此，手术治疗可能是这些患者的首选。
Background. Recent studies have reported that mixed-type (MT) gastric cancer, as per Lauren's classification, exhibits aggressive behavior. However, the behavior of early gastric cancer is unclear. In this study, we addressed the influence of mucosa-confined MT gastric cancer, according to Lauren's classification, on lymph node metastasis (LNM) and long-term outcomes.Methods. Among patients who underwent gastrectomy for gastric cancer from January 2000 to December 2012, 3170 had mucosa-confined gastric cancer. According to Lauren's classification, 1449 (45.7 %), 1528 (48.2 %), and 193 (6.1 %) patients had intestinal type (IT), diffuse type (DT), and MT cancer, respectively. Moreover, patients with MT cancer were histologically subdivided into IT-predominant MT (3.0 %) and DT-predominant MT (2.5 %) groups. We analyzed and compared the clinicopathological characteristics, incidence of LNM, overall survival, and recurrence-free survival between these groups.Results. Clinicopathological characteristics showed that mucosa-confined MT gastric cancer had larger size, deeper invasion, and more frequent lymphovascular invasion compared with IT or DT cancers. The LNM of MT lesions (4.7 %) was comparable with that of DT lesions (4.8 %), and multivariate logistic regression analysis indicated that Lauren's classification was a significant predictor for LNM (P < 0.001). However, the overall survival and recurrencefree survival of patients with MT lesions did not differ significantly (P = 0.506 and 0.359, respectively).Conclusions. Thus, among patients with mucosa-confined gastric cancer, those with MT cancer as per Lauren's classification have aggressive clinical features and a risk of LNM. Hence, surgical treatment may be the preferred option in these patients.