Application of minimally invasive treatment for early gastric cancer

BACKGROUND AND OBJECTIVES: Although various types of minimally invasive treatment have emerged as the best front-line therapies for early gastric cancer (EGC), there have been no established indications that these attempts are applicable. The purpose of this study was to propose indications for the application of minimally invasive therapy for EGC. METHODS: A total of 566 patients with EGC who had undergone gastrectomy with D2 or more extended lymphadenectomy, from July 1993 to December 1997 were retrospectively analyzed. The risk factors that determine lymph node metastasis were investigated by univariate and multivariate analysis. RESULTS: The rate of lymph node metastasis was 11.8% for all EGC, 3.4% for mucosal cancer, and 21.0% for submucosal cancer. Lymph node metastasis was associated with submucosal invasion, larger tumor size, undifferentiated histology, and the presence of lymphatic or blood vessel invasion (LBVI) by univariate and multivariate analyses. When LBVI was absent, there was no lymph node metastasis if the tumor was smaller than 2.5 cm with differentiated histology, and smaller than 1.5 cm with undifferentiated histology, regardless of depth of invasion. Extra-perigastric lymph node metastases were noted in patients with submucosal tumors that have LBVI while none of mucosal cancer showed extra-perigastric lymph node metastases. CONCLUSIONS: Minimally invasive treatment can be possibly applied for patients with EGC using these four independent risk factors for lymph node metastasis in EGC. For mucosal cancers, EMR is indicated for EGCs without lymph node involvement based on tumor size and histology. When we found LBVI by pathologic examination after EMR, gastrectomy with D1 lymph node dissection is mandatory. For submucosal cancers, patients with small tumors could be treated with laparoscopic wedge resection without lymph node dissection. However, patients with larger sized tumors or tumors with LBVI should be treated with extended (D2) lymph node dissection.     

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。     

Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis

Background

To combine clinicopathological characteristics associated with lymph node metastasis for submucosal gastric cancer into a nomogram.

Methods

We retrospectively analyzed 262 patients with submucosal gastric cancer who underwent D2 gastrectomy between 1996 and 2012. The relationship between lymph node metastasis and clinicopathological features was statistically analyzed. With multivariate logistic regression analysis, we made a nomogram to predict the possibility of lymph node metastasis. Receiver operating characteristic (ROC) analysis was also performed to assess the predictive value of the model. Discrimination and calibration were performed using internal validation.

Results

A total number of 48 (18.3%) patients with submucosal gastric cancer have pathologically lymph node metastasis. For submucosal gastric carcinoma, lymph node metastasis was associated with age, tumor location, macroscopic type, size, differentiation, histology, the existence of ulcer and lymphovascular invasion in univariate analysis (all P<0.05). The multivariate logistic regression analysis identified that age ≤50 years old, macroscopic type III or mixed, undifferentiated type, and presence of lymphovascular invasion were independent risk factors of lymph node metastasis in submucosal gastric cancer (all P<0.05). We constructed a predicting nomogram with all these factors for lymph node metastasis in submucosal gastric cancer with good discrimination [area under the curve (AUC) =0.844]. Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.

Conclusions

We developed a nomogram to predict the rate of lymph node metastasis for submucosal gastric cancer. With good discrimination and internal validation, the nomogram improved individualized predictions for assisting clinicians to make appropriated treatment decision for submucosal gastric cancer patients.     

Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer

Background We aimed to elucidate clinicopathological variables associated with lymph node metastasis of submucosal invasive gastric cancer. Methods Specimens were surgically resected from 201 patients who had primary submucosal gastric cancer. We studied 39 consecutive patients with lymph node metastasis and 162 patients without lymph node metastasis. We compared the following clinicopathological characteristics of the patients in relation to lymph node metastasis: age, sex, tumor size, histology, extent of submucosal invasion, lymphatic and venous invasion, and ulceration of the tumor. Submucosal invasion was divided subjectively into sm1, sm2, and sm3 (representing invasion of the upper-, middle-, and lower-third of the submucosa, respectively). We also studied the relationship between lymph node metastasis of submucosal gastric cancer and immunohistochemistry for p53, Ki67, vascular endothelial growth factor (VEGF), α-fetoprotein, sLe^a, and dendritic cells (DCs). Results In terms of conventional pathological factors, lymph node metastasis in submucosal gastric cancer was related to tumor size (P = 0.002), depth of submucosal invasion (P = 0.001), lymphatic invasion (P < 0.0001), and venous invasion (P = 0.012). Lymph node metastasis in sm1 gastric cancer was significantly related to VEGF expression (P = 0.047). Also, lymph node metastasis in sm3 gastric cancer was significantly correlated with DC expression (P = 0.016). Multivariate analysis showed that tumor size, tumor invasion depth in the submucosal layer, and lymphatic invasion were independent predictors of nodal metastasis in submucosal gastric cancer. Conclusion Conventional pathological factors, such as tumor size, depth of submucosal invasion, and lymphatic invasion, have a significant influence on lymph node metastasis. VEGF expression and DC expression may be helpful predictors of lymph node metastasis in patients with sm1 and sm3 gastric cancer, respectively.     

The expression pattern of UDP-N-acetyl-alpha-d-galactosamine: polypeptide N-acetylgalactosaminyl transferase-3 in early gastric carcinoma

BACKGROUND AND OBJECTIVES: Tumor development usually is accompanied by alterations of O-glycosylation. Initial glycosylation of mucin-type O-linked proteins is regulated by UDP-N-acetyl-alpha-d-galactosamine: polypeptide N-acetylgalactosaminyl transferase-3 (GalNAc-T3). Although the expression of GalNAc-T3 has been examined in various cancers, the expression has not been characterized in early stages of cancer. METHODS: Using the specific antibody, we evaluated the expression of GalNAc-T3 in 125 early gastric cancers that were treated as classical gastrectomy with lymphadenectomy, and analyzed the relationship between the expression of GalNAc-T3 and clinicopathological features. RESULTS: GalNac-T3 was positively expressed in 40 cases (76%) in differentiated carcinomas, whereas in only six cases (8%) in undifferentiated carcinomas (P < 0.001). Positive staining was observed in 17 (26%) intramucosal and in 29 (48%) submucosal carcinomas, indicating that GalNac-T3 tended to be highly expressed as the depth of invasion increased (P < 0.05). Lymph node metastasis tended to be observed more frequently in GalNac-T3 positive than negative cases, and the difference was significant in undifferentiated type cancer (P < 0.05). CONCLUSIONS: GalNAc-T3 expression was a useful indicator of tumor differentiation in early gastric cancer, and the expression had positive correlation with depth of tumor invasion and lymph node metastasis. This suggests that the overexpression of GalNAc-T3 may have a role in invasion and metastasis in early stages of gastric cancer.     

早期胃癌的淋巴结转移规律及预后分析

目的 分析早期胃癌的临床病理特征与预后之间的关系及早期胃癌的淋巴结转移规律.方法 对1994年1月～2005年10月手术治疗并有完整资料的255例早期胃癌的临床病理学资料进行回顾性分析.结果 255例患者的总5年生存率为91.4%.单因素分析显示,肿瘤浸润深度、脉管瘤栓和区域淋巴结转移与患者术后生存率有关;而性别、年龄...     

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.     

A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer

Currently in Japan, differentiated gastric submucosal invasive cancers <500 μm (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 × 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer.     

Indications for EMR/ESD in cases of early gastric cancer: relationship between histological type,depth of wall invasion,and lymph node metastasis

Background Limited surgery by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for gastric cancer is frequently performed in many institutions. These techniques do preserve gastric function and maintain a high quality of life but may compromise survival. The treatment strategy for early tumors should therefore be based on a complete cure, and limited surgery must thus have clear indications. Methods D2 gastric resection was performed in 278 early gastric adenocarcinomas, and a retrospective histological review of the specimens was made. The extended indications for EMR or ESD, according to the Japanese Gastric Cancer Association Treatment guidelines for gastric cancer in Japan, were also assessed. Results Of the 278 early gastric cancers, 115 were mucosal (M) cancers without ulcer. No lymph node metastases were seen in these specimens. Six of the 41 specimens of M cancer with ulcers had lymph node metastases at the N1 level only. One of these had lymph node metastases from a tumor measuring less than 3 cm in size. Twenty-eight of 122 submucosal cancers had lymph node metastases (23%). Twenty of these were SM1 tumors and 5 had lymph node metastases; 4 of these 5 had lymph node metastases despite the absence of vascular invasion. Conclusion Three cases had lymph node metastases that met the extended criteria for EMR/ESD. EMR and/or ESD should be limited to M cancers without ulcer or differentiated-type M cancer with ulcers smaller than 2 cm. When the depth of tumor invasion is deeper than M, then a gastric resection with lymph node dissection is necessary.     

Long-Term Outcomes after D2 Gastrectomy for Early Gastric Cancer: Survival Analysis of a Single-Center Experience in China

Background: Early gastric cancer (EGC) is well accepted as having a favorable prognosis, but some patients experience an ominous outcome after curative resection. This study was aimed at evaluating predictive factors associated with prognosis of D2 gastrectomies in patients with early gastric cancer. Materials and Methods: A total of 518 patients with early gastric cancer who underwent D2 gastrectomies were reviewed in this study. The clinicopathological features and surgical outcomes were analyzed. The survival rate was estimated using theKaplan-Meier method and compared by log rank test. Prognostic factors were analyzed using a multivariate Cox proportional hazards model. Results: The 5-year survival rate was 90.3%. Tumor infiltration, lymph node metastasis and lymphovascular invasion were significant prognostic factors for survival. Gender, age, tumor size, tumor location, macroscopic type and histological type were not significant prognostic factors. Multivariate analysis indicated that lymph node metastasis was an independent poor prognosis factor. Conclusions: Earlygastric cancers with lymph node metastasis have a relatively poor prognosis after standard surgery. Even after curative resection, patients with EGC with positive lymph nodes should be closely followed and be considered as candidates for comprehensive therapies.     

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer

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. Received: January 23, 2001 / Accepted: March 15, 2001     

Expression of stromal cell-derived factor-1α is an independent risk factor for lymph node metastasis in early gastric cancer

Lymph node metastasis is considered to be a significant prognostic factor for early gastric cancer (EGC). However, no real consensus exists on which patient and/or tumor characteristics are associated with lymph node metastasis. We investigated whether stromal cell-derived factor (SDF)-1α expression correlates with lymph node metastasis in patients with EGC by immunohistochemically examining the expression of SDF-1α in 138 archival tissue specimens of EGC. Of these specimens, 59 (42.8%) and 79 (57.2%) were grouped into SDF-1α-positive and SDF-1α-negative groups, respectively. No significant differences existed with respect to age, gender, tumor location, proportion of tumors >20 mm in size, macroscopic type, depth of invasion or histology between the SDF-1α-positive and -negative groups. However, the SDF-1α-positive group was significantly correlated with lymphovascular invasion and lymph node metastasis. Results of the univariate analyses indicated that lymphovascular invasion, undifferentiated histology and SDF-1α positivity were statistically significant risk factors affecting lymph node metastasis in patients with EGC. Multivariate analyses showed that lymphovascular invasion [hazard ratio (HR), 8.595; 95% confidence interval (CI), 1.694-43.595; P=0.009], undifferentiated histology (HR, 2.965; 95% CI, 1.037-8.471; P=0.043) and SDF-1α positivity (HR, 2.108; 95% CI, 1.316-10.135; P=0.013) were independent risk factors predicting lymph node metastasis in EGC. In conclusion, these results suggest that SDF-1α expression in tumor cells is a predictive marker of lymph node metastasis in EGC.     

内镜超声检查在早期胃癌术前分期的应用

目的　探讨内镜超声检查 (EUS)在早期胃癌术前分期中的临床应用价值。方法　对14 9例经胃镜活检证实的胃癌患者 (其中早期胃癌 33例 )术前行内镜超声检查 ,并与术后病理检查结果对照。结果　EUS对胃癌T分期的准确率为 80 .3% ,其中T1期为 81.8% ,T2期为 70 .4 % ,T3期为88.9% ,T4期为 71.4 %。EUS鉴别早期和进展期胃癌的准确率达 95 .1% ,而鉴别胃黏膜和黏膜下癌的准确率仅为 6 3.6 %。EUS对黏膜和黏膜下癌的判断准确率分别为 5 2 .9%和 75 .0 % ,而阳性预测值分别达 90 .0 %和 70 .6 %。EUS对隆起型和平坦型早期胃癌浸润深度的判断准确率均为 10 0 % ,对凹陷型的准确率仅 5 8.6 % ;对分化型和未分化型早期胃癌浸润深度的判断准确率分别为 71.4 %和5 7.9% ,差异无显著性 (P >0 .0 5 )。EUS对早期胃癌浸润深度的判断准确率随着肿瘤直径的增大而降低 ,对早期胃癌淋巴结状况的判断准确率为 90 .9% ,对淋巴结转移的敏感性和特异性分别为 6 6 .7%和 96 .3%。结论　内镜超声检查对早期胃癌术前分期具有较高的临床应用价值。     

Matrilsin expression is a useful marker of submucosal invasion and lymph node metastasis in early stage signet ring cell carcinoma of the stomach

BACKGROUND: Matrilysin (MMP-7) is considered to play an important role in tumor progression and metastasis. The aim of this study was to examine the MMP-7 expression of early-stage undifferentiated gastric carcinoma, and to investigate differences between gastric signet ring cell (SIG) and other undifferentiated carcinomas (non-SIG). METHODS: Immunohistochemical staining of MMP-7 was performed using specimens from 150 patients with early-stage gastric undifferentiated carcinomas (76 SIG, 74 non-SIG). RESULTS: SIG had a larger proportion of mucosal-confined carcinoma and a lower rate of lymphatic invasion than non-SIG (P < 0.05). The incidence of the positive expression of MMP-7 in submucosal SIG was significantly higher than that of mucosal SIG (P < 0.01). In contrast, MMP-7 expression was frequently found in mucosal non-SIG, suggesting an apparent difference in the invasiveness between mucosal SIG and non-SIG. The larger the size of the mucosal SIG, the more frequently MMP-7 positive expression was demonstrated (P < 0.05). There was a significant correlation between MMP-7 positive expression and lymph node metastasis of early SIG (P < 0.05). CONCLUSION: Early SIG revealed less invasiveness than non-SIG in terms of clinicopathologic features and MMP-7 expression. Preoperative estimation of the MMP-7 expression might be useful as a predictor of submucosal invasion and lymph node metastasis in early SIG.     

Prognostic role of lymph node metastasis in early gastric cancer

Objective： To clarify the relationship between clinicopathological features and lymph node metastasis and to propose the potential indications of lymph node metastasis for prognosis in early gaswic cancer （EGC） patients. Methods： We retrospectively observed 226 EGC patients with lymph node resection, and analyzed the associations between lymph node metastasis and clinicopathological parameters using the chi-square test in univariate analysis and logistic regression analysis in multivariate analysis. Overall survival analysis was determined using the Kaplan-Meier and log-rank test. We conducted multivariate prognosis analysis using the Cox proportional hazards model. Results： Of all the EGC patients, 7.5% （17/226） were histologically shown to have lymph node metastasis. The differentiation, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in EGC. The 5- and 10-year survival rates were significantly lower in patients with lymph node metastasis than in those without and the patients also had shorter progress-free survival time. Lymph node metastasis and tumor size were independent prognostic factors for EGC. The status of the lymph nodes was a significant factor in predicting recurrence or metastasis after surgery. Conclusions： The undifferentiated carcinoma and lymphovascular and/or submucosal invasion were associated with a higher incidence of lymph node metastasis in EGC patients, whom need to perform subsequent D2 lymphadenectomy or laparoscopic lymph node dissection and more rigorous follow-up or additional chemotherapy/radiation after D2 gastrectomy for poor prognosis and high recurrence/metastasis rate.     

The expression of thymidylate synthase and thymidine phosphorylase in the early-stage of gastric cancer

The immunohistochemical expression of thymidylate synthase (TS) and thymidine phosphorylase (TP) was investigated in 116 of early gastric cancer, in order to know whether or not these reflect malignity in an early stage. The materials conditioned on early gastric cancer with submucosal invasion and over 1 cm2 in size, were 57 with and 59 without lymph node metastasis. They were divided into two by the depth of invasion. The expressions of TS and TP in these group were compared with corresponding histopathological findings. Overall expressions of TS and TP were 54.3% and 34.5%, respectively. The TS-expression was not related with the depth of invasion and lymph node metastasis. The TP-expression, however, showed significant difference between with and without lymph node metastasis, and was so on the depth of submucosal invasion in the group without the nodal metastasis. Multivariate analysis showed that mucosal spread bordering 4 cm2 in size (p = 0.024) and lymphatic permeation (p = 0.099) in TS-expression, and lymph node metastasis (p = 0.041), submucosal invasion (p = 0.076) and venous permeation (p = 0.111) in TP-expression were the noticeable factors regarding to their high expression rates. Although these results were considered not to exceed gastric resection on the prognosis, they might be applicable as one of the indicators in postoperative follow-up on the minor resection of early gastric cancer such as EMR or local resection.     

Clinicopathological Characteristics as Predictive Factrs for Lymph Node Metastasis in Submucosal Gastric Cancer

OBJECTIVE To identify clinicopathological characteristics as predictive factors for lymph node metastasis in submucosal gastric cancer, and in addi- tion to establish objective criteria as indications for endoscopic submucosal dissection (ESD). METHODS Data from 130 patients with submucosal gastric cancer were collected, and the relationship between their clinicopathological characteris- tics and the presence of lymph node metastasis was retrospectively analyzed by multivariate analysis. RESULTS In the multivariate logistic regression model, a tumor size of 2 cm or more and an undifferentiated histologic type were found to be inde- pendent risk clinicopathological characteristics for lymph node metastasis. Among 130 patients with submucosal carcinoma, no lymph node metastases were observed in 17 patients who showed neither of the two risk clinicopath- ological characteristics. Lymph node metastasis occurred in 61.1% (22/36) of the patients who had both risk clinicopathological characteristics. CONCLUSION A tumor size of 2 cm or more and an undifferentiated histologic type were significantly and independently related to lymph node metastasis in submucosal gastric cancer. It is rational for the paitients with neither of these two independent risk clinicopathological characteristics to undergo an ESD.     

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。     

胃癌根治术后早期复发的临床病理特点及预后分析

目的:探讨胃癌根治术后早期复发的相关因素及预后分析。方法:回顾性分析235例胃癌根治术后复发患者的临床病理资料,对相关参数进行单因素和多因素分析。Kaplan-Meier法进行预后的生存分析。结果:235例患者平均复发时间为术后24.3个月,其中早期复发145例（≤2年）,晚期复发90例（＞2年）。单因素分析显示手术方式、肿瘤大小、脉管侵犯、浸润深度、淋巴结转移、TNM分期、术后化疗与早期复发相关（P<0.05）。多因素分析显示肿瘤大小（P=0.001）、淋巴结转移（P=0.007）、术后化疗（P=0.011）是早期复发的独立影响因素。生存分析显示肿瘤大小（P=0.013）、TNM分期（P<0.01）是预后的独立影响因素。结论:肿瘤大小、淋巴结转移、术后化疗是胃癌早期复发的独立影响因素,且预后与肿瘤大小、TNM分期密切相关。     

淋巴结转移阴性早期胃癌的临床病理特点及预后分析

目的:探讨淋巴结转移阴性早期胃癌的临床病理特点及其预后因素,为临床治疗提供理论依据。方法:回顾性分析1983年1 月～2003年12月河北医科大学附属邢台人民医院肿瘤外科收治132 例淋巴结转移阴性早期胃癌患者的临床病理特征与预后的关系。结果:淋巴结转移阴性与淋巴结转移阳性早期胃癌在肿瘤直径和浸润深度组间有显著性差异（P<0.05）。 两者在性别、年龄、家族史、肿瘤数目、肿瘤部位、大体类型和组织学类型分组中有显著性差异（P>0.05）。 本组获随访126 例,6 例失访,随访率为95.5% 。3 年生存率为91.3%（115/126）,5 年生存率为84.9%（107/126）。 单因素分析经Kaplan-Merier 分析筛选出浸润深度与淋巴结转移阴性早期胃癌预后关系密切（P=0.001）。 结果表明浸润深度是淋巴结阴性早期胃癌的独立预后因素。黏膜内癌患者的生存率与黏膜下癌者比较,差异有统计学意义（P<0.05）。 结论:浸润深度是淋巴结转移阴性早期胃癌的独立预后因素。术前或术中正确评估早期胃癌的淋巴结转移状态是选择合理的治疗方案和改善预后的重要条件。