Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer.
Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer.
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DOI：
10.1007/s101200100014
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发表时间：
2001-01-01
期刊：
影响因子：
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通讯作者：
Yamamura, Y
中科院分区：
文献类型：
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作者：
Seto, Y;Shimoyama, S;Yamamura, Y
背景：到目前为止，还没有关于术前确定浸润深度与淋巴结转移之间关系的报道。在日本胃癌协会的领导下，本研究旨在为早期胃癌（EGC）有限治疗的决策提供依据。方法：通过问卷调查收集日本8家大医院术前浸润深度为粘膜（m-癌）的胃癌2672例和EGCs 6209例，其中粘膜（m-）癌3584例，粘膜下（sm-）癌2625例。1985年至1998年间，所有登记的患者都接受了D1或更广泛淋巴结切除术的胃切除术。结果：术前m -癌浸润深度诊断准确率为80.2%（2144/2672）。然而，在2432例术中未观察到淋巴结受累的m -癌（N0）中，切除标本的组织学检查证实2353例（96.8%）未见淋巴结转移。早期胃癌、恶性胃癌和恶性胃癌的淋巴结转移率分别为8.9%、2.5%和17.6%。与分化组织学相比，淋巴结受累与未分化组织学的频率更高，以及与更大的肿瘤大小有关。直径小于4 cm的m-癌和直径小于1 cm的sm-癌的淋巴结转移发生率分别为1.3%（37/2837）和4.9%（4/82）。这些转移很少超出第一层。结论：N0和m-癌、直径小于4cm的m-癌和直径不大于1cm的sm-癌可能是有限手术的合适适应症。
BACKGROUND: No reports have, to date, focused on the relationship between preoperative determination of the depth of invasion and lymph node metastasis. The present study, under the leadership of the Japanese Gastric Cancer Association, was designed to form a basis for decision making in limited treatment for early gastric cancer (EGC).METHODS: From eight major hospitals in Japan, 2672 gastric cancers whose preoperative depth of invasion was mucosal(M-cancer), and 6209 EGCs, consisting of 3584 mucosal(m-) and 2625 submucosal(sm-) cancers, were collected by questionnaire. All registered patients underwent gastrectomy with D1 or more extensive lymphadenectomy between 1985 and 1998.RESULTS: The accuracy of preoperative diagnosis of depth of invasion of M-cancers was 80.2% (2144/2672). However, of the total of 2432 M-cancers in which no nodal involvement was observed intraoperatively (N0), histological examination of the resected specimens confirmed that lymph node metastasis was absent in 2353 (96.8%). The frequencies of lymph node metastasis in early gastric, m-, and sm-cancers were 8.9%, 2.5%, and 17.6%, respectively. Node involvement was associated with a higher frequency of undifferentiated than differentiated histology, as well as with greater tumor size. The incidences of lymph node metastasis in m-cancers with a diameter of less than 4 cm, and in sm-cancers with a diameter below 1 cm were 1.3% (37/2837) and 4.9% (4/82), respectively. These metastases rarely extended beyond the first tier.CONCLUSION: N0 and M-cancers, m-cancers less than 4 cm in diameter, and sm-cancers no larger than 1 cm in diameter may be appropriate indications for limited surgery.