未分化型早期胃癌的淋巴结转移规律分析

目的探讨未分化型早期胃癌(EGC)的淋巴结转移规律。方法对1994年1月至2008年12月手术治疗的335例早期胃癌的临床病理学资料进行回顾性分析。结果未分化型早期胃癌的淋巴结转移率为17.9%,其中黏膜内癌(M癌)和黏膜下层癌(SM癌)的淋巴结转移率分别为10.5%、25.6%,直径≤2.0cm和>2.0cm的淋巴结转移率分别为8.0%和25.8%,脉管瘤栓阳性和脉管瘤栓阴性的淋巴结转移率为50.0%和16.3%。单因素分析显示,肿瘤大小、浸润深度、脉管瘤栓与未分化型早期胃癌淋巴结转移相关(P<0.05)。多因素分析显示,肿瘤最大径>2cm、黏膜下层浸润和脉管瘤栓是未分化型早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、黏膜内癌、无脉管瘤栓的未分化型早期胃癌发生淋巴结转移风险小。     

胃黏膜内癌的淋巴结转移特点分析

目的探讨黏膜内早期胃癌(EGC)淋巴结转移的危险因素,为早期胃癌的个体化治疗提供依据。方法对1994年1月至2008年12月间接受根治性D2切除术的212例黏膜内早期胃癌患者的临床病理学资料进行回顾性分析,应用单因素和多因素Logistic回归分析评估影响黏膜内早期胃癌淋巴结转移的危险因素。结果 212例黏膜内早期胃癌患者的淋巴结转移率为3.3%(7/212),其中肿瘤最大径≤2cm和>2cm的淋巴结转移率分别为0.8%和7.5%;分化型与和分化型患者的淋巴结转移率分别为1.4%和7.1%;有脉管瘤栓和无脉管瘤栓患者的淋巴结转移率分别为100.0%和2.4%。多因素分析显示,肿瘤最大径>2cm、未分化型腺癌和脉管瘤栓是黏膜内早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、分化型腺癌和无脉管瘤栓的黏膜内早期胃癌发生淋巴结转移风险小,可作为制订个体化治疗方案的参考。     

低分化型黏膜内胃癌淋巴结转移的危险因素与腹腔镜手术探讨

  目的  探讨低分化型黏膜内胃癌淋巴结转移的危险因素, 从而对低分化型黏膜内胃癌患者, 制定合理腹腔镜术式提供理论依据。  方法  回顾性分析60例低分化型黏膜内胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。  结果  通过多因素分析, 多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性对淋巴结转移差异具有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素均有者, 淋巴结转移率高达66.7%。  结论  多发肿瘤, 肿瘤大小≥2 cm和淋巴管癌栓阳性是低分化型分化型黏膜内胃癌淋巴结转移的独立危险因素。对于无危险因素的患者, 行腹腔镜下胃局部切除术是可行的; 对于具有危险因素的患者, 可以实施腹腔镜下胃癌根治术治疗。      

早期低分化型胃癌淋巴结转移的危险因素与腹腔镜局部切除术的探讨

  目的  探讨早期低分化型胃癌淋巴结转移的危险因素, 从而对早期低分化型胃癌患者, 行腹腔镜下局部切除术提供理论依据。  方法  回顾性分析80例早期低分化型胃癌的临床病理资料, 按照临床病理特征与淋巴结转移的关系进行统计学分析。  结果  通过多因素分析, 肿瘤大小≥2cn, 黏膜下癌和淋巴管癌栓阳性对淋巴结转移有统计学意义(P < 0.05)。无危险因素的患者, 淋巴结转移率为0;三个危险因素都具有者, 淋巴结转移率高达42.9%。  结论  肿瘤大小≥2 cm, 黏膜下癌和淋巴管癌栓阳性是早期低分化型胃癌淋巴结转移的独立危险因素对于早期低分化型胃癌患者, 行腹腔镜下局部切除术, 这三项危险因素是判断是否进行附加手术的简单标准。      

黏膜内早期胃癌青年患者临床病理特征及内镜下治疗适应证的探讨

  目的  探讨青年患者黏膜内早期胃癌临床病理特征、淋巴结转移风险及内镜黏膜下剥离术（endoscopic submucosal dissec? tion，ESD）适应证。  方法  回顾性选取2009年3月至2016年12月在安徽省立医院行胃癌根治术、临床病理资料完整的325例早期胃癌患者，所有患者均经术后病理证实为黏膜内癌。根据年龄（≤40岁和>40岁）分为青年组和中老年组，总结青年组临床病理特征和ESD治疗安全性。  结果  在所有黏膜内早期胃癌患者中，青年组患者30例（9.2%）。与中老年组相比，青年组黏膜内癌多发生于女性，病理类型以未分化型和混合型为主，更容易发生淋巴结转移。符合ESD适应证的分化型黏膜内癌的患者中，青年组淋巴结转移率为0；符合ESD相对适应证的未分化型黏膜内癌的患者中，青年组淋巴结转移率高达25.0%。  结论  青年患者黏膜内早期胃癌病理分化程度差，侵袭性更强，分化型黏膜内癌可考虑ESD治疗。      

早期胃癌淋巴结转移因素分析

目的探讨影响早期胃癌淋巴结转移的因素。方法对74例术后早期胃癌患者的资料,对各临床病理指标与淋巴结转移的关系进行分析,以确定淋巴结转移的危险因素。结果早期胃癌患者的淋巴结转移率为14.9%（11/74）。单因素分析显示黏膜下癌的淋巴结转移率（27.6%）明显高于黏膜内癌（6.7%）（P=0.020）;未分化型癌的淋巴结转移率（27.6%）明显高于分化型（6.8%）（P=0.042）;肿瘤最大径≤2 cm、〉2-4 cm、〉4 cm 3组间淋巴结转移率有统计学意义（χ2=6.549,P=0.038）。采用Log istic回归进行的多因素分析显示,肿瘤最大径（OR=2.688,P=0.047）和浸润深度（OR=4.508,P=0.044）是影响早期胃癌淋巴结转移的独立危险因素。结论早期胃癌淋巴结转移与肿瘤最大径和浸润深度密切相关,这可为手术方案的选择提供参考。     

影响早期胃癌预后及淋巴结转移因素分析

[目的]分析影响早期胃癌生存期的因素并探讨年龄、性别及临床病理特点对早期胃癌淋巴结转移的影响。[方法]收集1979年7月至2004年8月在福建医科大学附属协和医院肿瘤内科治疗的161例早期胃癌患者的临床资料,并应用BinaryLogistic回归、寿命表法和Cox回归等方法进行统计学分析。[结果]单因素分析影响生存期的因素有:浸润深度、淋巴结转移、淋巴管瘤栓、静脉瘤栓、病灶数目、肿瘤大小、淋巴结清扫范围;多因素分析独立影响因素有:淋巴结转移。淋巴结转移率14.9%(24/161),单因素分析影响淋巴结转移的因素有:浸润深度、淋巴管瘤栓、肿瘤大小和病理类型;多因素分析独立影响因素有:浸润深度和病理类型。[结论]对侵及黏膜下层、未分化型、术前或术中检测淋巴结转移阳性的早期胃癌应尽可能扩大手术范围(D2淋巴结清扫术),以提高早期胃癌的长期生存率。     

未分化型早期胃癌淋巴结转移的影响因素分析

摘 要：［目的］ 研究未分化型早期胃癌临床病理特征、血清肿瘤标志物与胃癌淋巴结转移的相关性。［方法］ 选择接受胃癌根治术并经术后病理诊断为未分化型早期胃癌患者80例,分析内镜特征、临床病理特征、术前血清肿瘤标志物与胃癌淋巴结转移的相关性。［结果］ 80例患者中,18例有淋巴结转移。有淋巴结转移组患者黏膜下癌比例、有脉管浸润比例、血清G-17含量均明显高于无淋巴结转移组患者,血清PG-Ⅱ/PG-Ⅰ比值明显低于无淋巴结转移组患者,差异均有统计学意义（P均<0.05）。Logistics回归分析显示,黏膜下癌（OR=1.944,95%CI：1.452～2.853）、脉管浸润（OR=1.775,95%CI：1.378～2.512）、术前血清G-17升高（OR=1.661,95%CI：1.277～2.451）及PG-Ⅱ/PG-Ⅰ比值降低（OR=2.039,95%CI：1.503～2.849）是未分化型早期胃癌淋巴结转移的独立危险因素。［结论］ 黏膜下癌、脉管浸润、术前血清G-17升高及PG-Ⅱ/PG-Ⅰ比值降低可能增加未分化型早期胃癌淋巴结转移的风险。     

早期胃癌不同淋巴结清除术的合理评价

目的 合理选择早期胃癌不同淋巴结清除术式。方法 以临床病理资料完整的325例早期胃癌为研究对象,总结其各站淋巴结转移规律及其不同淋巴结清除术的效率,并分析淋巴结转移与病理生物学行为的相关性。结果 全组淋巴结转移率为14．8％,转移度为3．0％。胃下部癌第1站淋巴结转移率为14．5％,各号淋巴结均有转移;第Ⅱ站淋巴结转移率为6．9％,以No．7、8a淋巴结转移率较高,而No．1、9、11P、12a和14v淋巴结几乎无转移。胃中部癌第Ⅰ站淋巴结转移率为13．8％,No．1、3、5、6淋巴结有转移;第Ⅱ站淋巴结转移率为6．9％,仅№．7、8a淋巴结有转移。大癌灶（〉3．0cm）、黏膜下癌、低分化和淋巴管癌栓阳性者的第Ⅰ、Ⅱ站淋巴结转移率较小癌灶（≤3．0cm）、黏膜内癌、高分化和淋巴管癌栓阴性者明显增高（P〈0．05）。结论 单纯D,或D1＋No．7淋巴结清除术适合于癌灶直径≤1．0cm或黏膜内癌;D1＋No．7、8a淋巴结清除术适合于早期胃中、下部癌中直径〉1．0cm、凹陷型、黏膜下癌,其中癌灶直径〉3．0cm、淋巴管癌栓阳性者应加行No．1、9淋巴结清除;标准D：、D,淋巴结清除术应尽量避免施行。     

早期胃癌的浸润深度与淋巴结转移关系

目的:探讨早期胃癌的浸润深度、肿瘤大小与淋巴结转移之间的相关性.方法:收集103例外科手术切除的早期胃癌,统计不同时期早期胃癌的检出率,分析其临床及病理特点.结果:103例早期胃癌中黏膜内癌(M)31例,仅有1例(3%)淋巴结转移,黏膜下癌(SM)有63例,淋巴结转移率为17%,其中SM1:16.1%,SM2:34%,SM3:35%;肿瘤最大直径超过2cm的淋巴结转移率(20%)较直径≤2cm者(8.8%)高;肉眼类型中Ⅱ型最多见,并淋巴结转移率也最高;组织类型中高分化腺癌最多,其次为低分化腺癌;且低分化腺癌淋巴结转移率高.结论:早期胃癌的淋巴结转移与肿瘤的浸润深度、肿瘤的大小、肉眼所见及组织类型有关.     

Predictive factors of lymph node metastasis in undifferentiated early gastric cancers and application of endoscopic mucosal resection

BackgroundFor intramucosal undifferentiated early gastric cancer (EGC), gastrectomy with lymphadenectomy is now the standard therapy. However, because approximately 96% of intramucosal undifferentiated EGC do not have lymph node metastasis (LNM). Gastrectomy with lymphadenectomy may be overtreatment for such patients. This study was conducted to identify clinicopathological factors predictive of LNM in undifferentiated EGC and further to expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of undifferentiated EGC.MethodsData from 108 patients with undifferentiated EGC and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM were retrospectively analyzed by univariate and multivariate logistic regression analyses. Odds ratios (ORs) with 95% confidence interval (95% CI) were calculated.ResultsThe tumor size (OR = 11.475, 95% CI: 2.054–64.104, P = 0.005), depth of invasion (OR = 11.704, 95% CI: 2.536–54.010, P = 0.002), and lymphatic vessel involvement (LVI) (OR = 13.688, 95% CI: 1.779–105.324, P = 0.012) that were significantly associated with LNM by univariate analysis, were found to be significant and independent risk factors for LNM by multivariate analysis. The LNM rates were 5% (3/61) and 28% (13/47) with intramucosal and submucosal undifferentiated EGC respectively. LNM was observed in 50% (1/2) of patients with both risk factors (tumor larger than 2.0 cm and the presence of LVI) but in none of 25 patients without the two risk factors in intramucosal undifferentiated EGC. The 5-year survival rates were 88%, 82% and 50%, respectively in cases with none, one and two of the risk factors respectively in intramucosal undifferentiated EGC (P < 0.05).ConclusionsA tumor larger than 2.0 cm, submucosal invasion, and the presence of LVI are independently associated with the presence of LNM in undifferentiated EGC. EMR alone may be sufficient treatment for intramucosal undifferentiated EGC if the tumor is less than or equal to 2 cm in size, and when LVI is absent upon postoperative histological examination. When specimens show with LVI, unexpected submucosal invasion, and unexpectedly larger tumor size than that determined at pre-EMR endoscopic diagnosis, an additional radical gastrectomy is probably better for these patients.     

Predictive factors of lymph node metastasis in intramucosal poorly differentiated early gastric cancer and their impact on the laparoscopic surgery

Objective

The aim of this study was to identify clinicopathological factors predictive of lymph node metastasis (LNM) in intramucosal poorly differentiated early gastric cancer (EGC), and further to expand the possibility of using laparoscopic surgery for the treatment of intramucosal poorly differentiated EGC.

Methods

Data from 65 patients with intramucosal poorly differentiated EGC and surgically treated were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.

Results

Univariate analysis showed that number of tumors, tumor size and lymphatic vessel involvement (LVI) were the significant and independent risk factors for LNM (all P < 0.05). The LNM rates were 5.0%, 18.2% and 66.7%, respectively. There was no LNM in 31 patients without the three risk clinicopathological factors

Conclusion

The number of tumors, tumor size, and LVI are independently associated with the presence of LNM in intramucosal poorly differentiated EGC. Thus, these three risk factors may be used to set as a simple criterion to expand the possibility of using laparoscopic surgery for the treatment of intramucosal poorly differentiated EGC.     

Lymph node metastasis risk factors and applicability of endoscopic submucosal dissection in mixed-type early gastric cancer in Chinese patients

BackgroundTo analyze the risk factors of lymph node metastasis (LNM) of mixed-type early gastric cancer (EGC), and to explore whether endoscopic submucosal dissection (ESD) is applicable to mixed-type EGC in Chinese patients.MethodsA total of 812 EGC patients were included. We classified the lesions into four types: pure moderately differentiated (PMD) adenocarcinoma, mixed predominantly moderately differentiated (MMD) type, mixed predominantly poorly differentiated (MPD) type, and pure poorly differentiated (PPD) adenocarcinoma. LNM risk factors in EGC were evaluated by univariate and multivariate analyses, and the feasibility of ESD in mixed-type EGC was estimated.ResultsThe LNM rate in mixed-type EGC was 24.7% (68/275). Tumor size [odds ratio (OR) =1.419, P=0.008], MPD (OR =3.278, P=0.002), submucosal invasion ≥500 µm (OR =5.059, P=0.002), and lymphovascular invasion (LVI) (OR =5.836, P<0.001) were independent predictors of LNM in mixed-type EGC. LNM was more common in MMD patients than in PMD patients who met the expanded indications for ESD of differentiated EGC (0.0% vs. 7.84%, P=0.005).ConclusionsTumor size, histology, invasion depth, and LVI are independent risk factors for LNM in mixed-type EGC. The absolute indications for ESD are applicable to MMD, and the feasibility of the expanded indications for ESD in MMD and MPD requires further investigation in Chinese patients.     

Lymph Node Metastasis in Early Signet Ring Cell Carcinoma:Endoscopic Mucosal Resection

Objective:To identify clinicopathological factors predictive of lymph node metastases(LNM)in early signet ring cell carcinoma(SRC),and further to expand the possibility of using endoscopic mucosal resection(EMR)for the treatment of early SRC.Methods:Data from 27 surgically treated patients with early SRC were collected,and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses.Results:In the ...     

Risk Factors for Lymph Node Metastasis and Endoscopic Treatment Strategies of Undifferentiated Early Gastric Cancer

OBJECTIVE To discuss the effects of clinico-pathological features on lymph node metastasis (LNM) in undifferentiated EGC (early gastric cancer), as well as identify the appropriate medical management. METHODS From January 1999 to June 2011, 352 patients were treated for undifferentiated EGC in our hospital. All patients had undergone gastrectomy with regional lymphadenectomy. We used univariate and multivariate analyses to determine the features associated with lymph node metastasis in patients with undifferentiated EGC. RESULTS Signet ring cell carcinoma (SRC) was more common in patients with undifferentiated EGC than other undifferentiated carcinoma (UDC). SRC had a tendency to be confined to the mucosa, with a smaller size than other UDC. The incidence of LNM for SRC was lower than that for other UDC. Multivariate analysis showed that LNM was associated with the sex, tumor size, depth of invasion,lymphovascular invasion, and histological type. CONCLUSION Complete endoscopic resection is suitable for SRCtype intramucosal EGC, which is less than 2 cm in diameter without lymphovascular invasion in the postoperative histological examination.     

Lymph Node Metastasis in Early Signet Ring Cell Carcinoma： Endoscopic Mucosal Resection

Objective  To identify clinicopathological factors predictive of lymph node metastases (LNM) in early signet ring cell carcinoma (SRC), and further to expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of early SRC. Methods  Data from 27 surgically treated patients with early SRC were collected, and the association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. Results  In the univariate analysis, a tumor larger than 3.0 cm, submucosal invasion, and the presence of lymphatic vessel involvement (LVI) were significantly associated with a higher rate of LNM (all P<0.05). In the multivariate model, the presence of LVI was found of to be an independent pathological risk factor for LNM. There was no LNM in 14 patients without the three clinicopathological risk factors (a tumor larger than 3.0 cm, submucosal invasion, and the presence of LVI). Conclusion  EMR alone may be sufficient treatment for intramucosal early SRC if the tumor is less than or equal to 3.0 cm in size, and when LVI is absent upon postoperative histological examination. When specimens show LVI, an additional radical gastrectomy with lymphadenectomy should be recommended. This work was supported by the Nature Science Foundation of Liaoning Province(No. 20042071).     

Predictable factors for lymph node metastasis in early gastric cancer analysis of clinicopathologic factors and biological markers

Predicting lymph node metastasis (LNM) accurately is very important to decide treatment strategies preoperatively. The aim of this study was to explore risk factors that predict the presence of LNM in early gastric cancer (EGC). A total of 230 patients with EGC who underwent curative gastrectomy with lymph adenectomy at Xinhua Hospital from January 2006 to July 2014 were retrospectively reviewed. We studied the relationship between clinicopathological factors, biological markers (p53, ki67, nm23, vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), E-cadherin (E-cad), beta-catenin (b-catenin), glutathione S-transferase (GST), and topoisomerase II (Topo II)), and LNM of EGC patients by chi-square test and logistic regression analysis. Meta-analyses were further conducted to review the effects of the proteins (P53, ki67, E-cad, and b-catenin) on LNM in ECG patients. LNM was detected in 42 (18.3 %) of 230 patients. Incidences of LNM was distinct in different tumor size (p?=?0.044), depth of submucosal invasion (p?<?0.0001), and P53 overexpression (p?=?0.004). Multivariate analysis further indentified that large tumor size (≥20 mm, odds ratio (OR)?=?2.168, p?=?0.041), submucosa (OR?=?4.000, p?=?0.0005), and P53 overexpression (OR?=?3.010, p?=?0.022) were independent risk factors of LNM in EGC patients. The meta-analysis revealed a significantly statistical association of P53, ki67, and b-catenin with an increased risk of LNM in EGC patients (P53, OR?=?1.81, p?=?0.017; ki67, OR?=?2.53, p?=?0.0003; b-catenin, OR?=?0.53, p?=?0.01). Tumor size (≥20 mm), the depth of invasion (submucosa), and P53 overexpression may be helpful predictors of LNM in EGC patients. Furthermore, the results of meta-analysis revealed that P53, ki67 overexpression, and abnormal expression of b-catenin may be associated with LNM in EGC. The results need further validation in single large studies.     

Lymphatic vascular invasion is an independent correlated factor for lymph node metastasis and the prognosis of resectable T2 gastric cancer patients

The objective of this study was to investigate the independent correlated factors for lymph node metastasis (LNM) and prognosis in T2 gastric cancer patients. A total of 135 pathologically confirmed T2 gastric cancer patients who received a gastrectomy at the Beijing University Cancer Hospital from Dec 1999 to Dec 2006 were studied retrospectively. The potential correlated factors for LNM and patients’ prognosis were analyzed, including gender, age, tumor location and size, depth of invasion, lymphatic vascular invasion (LVI), differentiation grade, histological type, Borrmann type, LNM, distant metastasis, TNM stage, and whether the patient was treated with a radical gastrectomy. LNM occurred in 69 patients, which represents a rate of LNM of 51.1 %. Multivariate logistic regression analysis showed that LVI and TNM stage were independent risk factors for LNM (p values were 0.002 and 0.029, respectively). The median follow-up time was 60.3 months. Multivariable survival analysis revealed that age (<60 vs. ≥60), TNM stage and LVI were independent prognostic factors for gastric cancer patients (p values were <0.001, 0.047, and 0.001, respectively). In conclusion, LVI was an independent factor for LNM and the prognosis of resectable T2 gastric cancer patients.