The Risk Factors of Lymph Node Metastasis in Early Gastric Cancer
The Risk Factors of Lymph Node Metastasis in Early Gastric Cancer
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DOI：
10.1007/s12253-015-9920-0
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发表时间：
2015-09-01
影响因子：
2.8
通讯作者：
Li, Anna Fen-Yau
中科院分区：
文献类型：
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作者：
Fang, Wen-Liang;Huang, Kuo-Hung;Li, Anna Fen-Yau
内镜下黏膜切除术（EMR）或内镜下黏膜下剥离术（ESD）是早期胃癌的有效替代治疗方法。然而，一个主要的问题是淋巴结转移的可能性。从1987年12月至2006年12月，391例接受根治性手术的胃癌患者，其中粘膜（T1 a，n = 265）或粘膜下（T1 b，n = 126）浸润，淋巴结回收数为千分之15。分析淋巴结转移的发生率及危险因素。T1 a期淋巴结转移率为4.9%，T1 b期淋巴结转移率为21.4%。虽然粘膜下肿瘤浸润深度< 2 mm，但有28. 6%的机会发生淋巴结转移。T1 b病变，即，粘膜下肿瘤浸润宽度< 5 mm者淋巴结转移率低于宽度> 5 mm者。多因素分析显示，Lauren弥漫型和淋巴管浸润是T1 a期淋巴结转移的独立危险因素，而淋巴管浸润是T1 b期淋巴结转移的最强危险因素。EMR/ESD是治疗无淋巴管浸润的T1 a肠型腺癌的良好选择。T1 b期胃癌伴淋巴结转移者应行手术切除。
Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is an effective alternative treatment for early gastric cancer. However, a major concern is the likelihood of lymph node metastasis. From December 1987 to December 2006, 391 patients who underwent curative surgery for gastric cancer with mucosal (T1a, n = 265) or submucosal (T1b, n = 126) invasion and a retrieved lymph node numbera parts per thousand 15 were enrolled. The frequency and risk factors of lymph node metastasis were analyzed. The frequency of lymph node metastasis was 4.9 % in T1a lesions and 21.4 % in T1b lesions. Although the depth of submucosal tumor invasion was < 2 mm, there was a 28.6 % chance of lymph node metastasis. A T1b lesion, i.e., the width of the submucosal tumor invasion was < 5 mm, resulted in fewer lymph node metastases than lesions > 5 mm in width. Multivariate analysis demonstrated that Lauren's diffuse type and lymphatic invasion were independent risk factors for lymph node metastasis in T1a lesions, while lymphatic invasion was the strongest risk factor for lymph node metastasis in T1b lesions. EMR/ESD is a good alternative for T1a intestinal type adenocarcinoma without lymphatic invasion. Surgical resection is necessary for patients with T1b gastric cancer with lymphatic invasion.