Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection
Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection
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DOI：
10.1007/s10120-012-0220-z
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发表时间：
2013-10-01
期刊：
影响因子：
7.4
通讯作者：
Nakajima, Takashi
中科院分区：
文献类型：
--
作者：
Takizawa, Kohei;Ono, Hiroyuki;Nakajima, Takashi
早期胃癌（EGC）与混合型组织学（分化和未分化）的行为是不完全了解。本研究回顾性分析了410例粘膜内型食管癌手术切除的临床病理资料，旨在探讨混合型食管癌的临床病理特征及其与淋巴结转移的关系。根据组织病理学中分化和未分化成分的比例，将病变分为4种类型：纯分化（PD）型、以分化为主的混合型（MD）型、以未分化为主的混合型（MU）型和纯未分化（PU）型。我们研究了PD和MD之间、PU和MU之间的临床病理差异，以及根据肿瘤大小和溃疡的LN转移率。中分化腺癌是MD相对于PD的主要组成部分（90.7%对46.1%）。印戒细胞癌是PU相对于MU的主要组成部分（81.5%对33.3%）。LN转移在MU比PU更常见（19.0vs.6.0%）。对于大于20 mm且无淋巴管浸润和溃疡的粘膜内肿瘤，MD和MU的LN转移率分别为0%和24%。对于小于30 mm的粘膜内病变伴溃疡但无淋巴管浸润，LN转移率MD为0%，MU为20%。组织学上以未分化成分为主的混合型EGC应作为未分化型肿瘤处理。需要进一步的调查，以确定是否混合型EGC与分化成分占主导地位的管理方式作为分化型EGC。
The behavior of early gastric cancer (EGC) with mixed-type histology (differentiated and undifferentiated) is incompletely understood. This study aimed to clarify the clinicopathological features of EGC with mixed-type histology in relation to lymph node (LN) metastasis.Clinicopathological data from 410 patients who underwent surgical resection for intramucosal EGC were reviewed. Lesions were classified into four types according to the proportion of differentiated and undifferentiated components at histopathology: pure differentiated (PD) type, mixed predominantly differentiated (MD) type, mixed predominantly undifferentiated (MU) type, and pure undifferentiated (PU) type. We examined the clinicopathological differences between PD and MD, and between PU and MU, and the rate of LN metastasis according to tumor size and ulceration.Moderately differentiated adenocarcinoma was the primary component in MD relative to PD (90.7 vs. 46.1 %). Signet ring cell carcinoma was the main component in PU relative to MU (81.5 vs. 33.3 %). LN metastasis was more common in MU than PU (19.0 vs. 6.0 %). For intramucosal tumors larger than 20 mm without lymphovascular invasion and without ulceration, the rate of LN metastasis was 0 % for MD and 24 % for MU. For intramucosal lesions less than 30 mm with ulceration but without lymphovascular invasion, the rate of LN metastasis was 0 % for MD and 20 % for MU.Histologically mixed-type EGC with a predominantly undifferentiated component should be managed as an undifferentiated-type tumor. Further investigation is required to determine whether mixed-type EGC with a predominantly differentiated component could be managed the same way as a differentiated-type EGC.