Additive Lymph Node Dissection may be Necessary in Minute Submucosal Cancer of the Stomach after Endoscopic Resection
Additive Lymph Node Dissection may be Necessary in Minute Submucosal Cancer of the Stomach after Endoscopic Resection
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DOI：
10.1245/s10434-011-2081-9
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发表时间：
2012-03-01
影响因子：
3.7
通讯作者：
Noh, Sung Hoon
中科院分区：
文献类型：
--
作者：
Kim, Jie-Hyun;Lee, Yong Chan;Noh, Sung Hoon
在早期胃癌（EGC）中，微小的胃粘膜下（SM 1）浸润已被认为是内镜切除（ER）的扩展适应症。在ER之前准确预测SM 1侵袭可能是困难的。因此，SM 1的侵袭可能是决定ER后加药治疗的重要因素。本研究的目的是调查淋巴结转移（LNM）在SM 1-EGC的手术标本的基础上的发病率，并评估的因素，表明额外的治疗后ER。从2005年5月至2008年12月，1,676例EGC患者在Severance和江南Severance医院，首尔，韩国进行手术。其中，126例患者被诊断为分化型SM 1-EGC。分析了LNM和淋巴管浸润（LVI）的临床病理特征，LVI是LNM的已知独立危险因素。肿瘤内标记物免疫组化检测作为LVI的预测因子。平均SM 1浸润深度为621.3 ± 745.6 μ m。分化型SM 1-EGC（6.3%）和满足ER扩展适应症的SM 1-EGC（4.1%）之间的LNM率无显著差异。女性、中分化、LVI、LVI分级与LNM呈正相关。女性和病变形态学升高与LVI相关。VEGF-C和OPHN 1在LV I阳性组织中的表达水平较高，本研究中符合扩大ER标准的分化型SM 1-EGC的LNM率为4.1%，提示部分SM 1-EGC患者ER后可能需要额外的淋巴结清扫。
In early gastric cancer (EGC), minute submucosal (SM1) invasion of the stomach has been regarded as an expanded indication for endoscopic resection (ER). The exact prediction of SM1 invasion before ER may be difficult. Thus, SM1 invasion may be important to decide additive treatment after ER. This study was designed to investigate the incidence of lymph node metastasis (LNM) in SM1-EGC based on surgical specimens and to evaluate the factors that indicate additional treatment after ER.From May 2005 to December 2008, 1,676 patients with EGC underwent surgery at Severance and Gangnam Severance Hospital, Seoul, Korea. Among them, 126 patients were diagnosed with differentiated SM1-EGC. The clinicopathologic characteristics were analyzed with respect to LNM and lymphovascular invasion (LVI), which is a known independent risk factor for LNM. Intratumoral marker immunohistochemistry was examined as a predictor of LVI.The mean SM1 invasion depth was 621.3 +/- A 745.6 mu m. The LNM rates did not differ significantly between differentiated SM1-EGC (6.3%) and SM1-EGC (4.1%) meeting the expanded indication for ER. Female gender, moderate differentiation, LVI, and LVI grade were positively correlated with LNM. Female gender and elevated lesion morphology were associated with LVI. The expression levels of VEGF-C and OPHN1 were higher in LVI-positive tissues.The LNM rate in differentiated SM1-EGC meeting the expanded ER criteria was 4.1% in the present study, indicating that additional lymph node dissection may be necessary after ER in some cases of SM1-EGC.