Risk Factors of Lymph Node Metastasis in Patients with Early Pure and Mixed Signet Ring Cell Gastric Carcinomas
Risk Factors of Lymph Node Metastasis in Patients with Early Pure and Mixed Signet Ring Cell Gastric Carcinomas
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早期纯性和混合性印戒细胞胃癌患者淋巴结转移的危险因素
DOI：
10.7150/jca.29245
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Xu, Guifang
中科院分区：
文献类型：
--
作者：
Hu, Qingqing;Dekusaah, Raymond;Xu, Guifang
背景资料：早期胃癌合并单纯印戒细胞癌预后良好，淋巴结转移风险低。然而，早期胃混合印戒细胞癌（mSRCC）的LNM的危险因素和临床病理特征仍缺乏研究。本研究的目的是确定LNM的危险因素，并比较早期胃pSRCC和mSRCC的临床病理特征和预后。研究方法：本回顾性研究于2005年至2015年在我中心进行，共796例患者接受了根治性胃切除术联合淋巴结清扫术，共回顾了160例早期胃SRCC患者接受了胃切除术联合淋巴结清扫术，其中79例为pSRCC，81例为mSRCC。比较两组患者的年龄、性别、肿瘤部位、大体类型、肿瘤大小、浸润深度、淋巴管浸润（LVI）、幽门螺杆菌（Hp）感染、萎缩性胃炎、溃疡及淋巴结转移等临床病理特征。随访患者切除术后生存情况。采用Kaplain-Meier法结合log-rank检验估计5年生存率和疾病特异性生存率，并比较两组间的差异。结果如下：肿瘤大小（P<0.05）、浸润深度（P<0.05）、LVI（P < 0.0001）是LNM的危险因素，LVI（P < 0.0001）是LNM的独立危险因素。单因素分析显示pSRCC组LVI（P < 0.0001）是LNM的危险因素，mSRCC组LNM的危险因素包括LVI（P < 0.0001）和肿瘤大小（P<0.05）。多变量分析显示mSRCC组有两个独立的危险因素：1）肿瘤大小（P < 0.05）和2）LVI（P < 0.0001）。两组患者的性别、大体类型、LVI、Hp感染等特征有显著性差异（P <0.0001）。160例扩大适应证与非适应证患者的LNM发生率差异有统计学意义（P=0.03）。早期胃SRCC的5年生存率为96.3%。两组的总生存期和疾病特异性生存期无显著差异。结论：尽管切除后生存率相似，但与早期pSRCC组相比，早期mSRCC组LNM的独立风险因素包括肿瘤大小和LVI。早期胃mSRCC比pSRCC具有更侵袭性的临床病理特征。
Background: Early gastric carcinoma (EGC) with pure signet ring cell carcinoma (pSRCC) has been reported to have favourable prognosis and low risk of lymph node metastasis (LNM). However, risk factors of LNM and clinicopathological features for early gastric mixed signet ring cell carcinoma (mSRCC) remain poorly investigated. The aim of this study was to identify risk factors of LNM and compare clinicopathological characteristics and prognosis of early gastric pSRCC with mSRCC. Methods: This retrospective study was conducted at our center between 2005 and 2015 in 796 patients underwent radical gastrectomies combined with lymph node dissections, A total of 160 patients with early gastric SRCC underwent gastrectomies with lymph node dissections were reviewed, in which 79 cases were pSRCC and 81 cases were mSRCC. Risk factors of LNM and clinicopathologic features of these two groups were statistically compared, including age, gender, tumor location, gross pattern, size, invasion depth, lymphovascular invasion (LVI), helicobacter pylori (Hp) infection, atrophic gastritis, ulcer finding and LNM. Patients were follow-up for post-resection survival. The 5-year survival and disease-specific survival rate were estimated with the Kaplain-Meier method with a log-rank test and compared between the two groups. Results: Tumor size (P<0.05), invision depth (P<0.05) and LVI (P < 0.0001) were risk factors of LNM, LVI (P < 0.0001) was independent risk factor of LNM in 160 patients. Univariate analysis reviewed LVI (P < 0.0001) as the risk factor in the pSRCC group, and the risk factors of LNM in the mSRCC included LVI (P < 0.0001) and tumor size (P<0.05). Multivariable analysis revealed two independent risk factors in the mSRCC group: 1) tumor size (P < 0.05), and 2) LVI (P < 0.0001). The significant characteristics in two groups included the male gender (P < 0.0001), gross pattern (P < 0.05), LVI (P < 0.01), and Hp infection (P < 0.01). The difference of LNM rate between expanded indication and out of indication in 160 patients was significant (P=0.03). The overall 5-year survival rate for early gastric SRCC was 96.3%. There was no significant difference in the overall survival and disease-specific survival between the two groups. Conclusions: Although with similar post-resection survival, the independent risk factors of LNM in the early mSRCC group, compared to those in the early pSRCC group, included large tumor size and LVI. Early gastric mSRCC had more aggressive clinicopathological features than pSRCC.