韩国早期胃癌的临床病理特征

尽管胃癌的发病率在不断下降，胃癌仍然是引起死亡的癌症中最常见的一种。相对而言，局限于粘膜和粘膜下组织的早期胃癌，无论有没有淋巴结的转移，一般都有较好的预后。西方及日本的研究结果均表明，近年来早期胃癌成增长趋势，并将此归因于诊断手段的进步，特别是内窥镜目标活检的应用。本研究通过回顾汉城Yousei大学医学院康复医院从1976～1995年间的胃癌病例，旨在获得韩国早期胃癌的临床病理特征。     

早期胃癌152例的临床病理特征和术后生存率

关于早期胃癌的研究日本报道最多,中国、美国等其他国家都有报道,他们多注重定义,临床病理特征,发病率,术后复发和5年生存率。早期胃癌得到及时手术机遇远远低于中晚期胃癌,各国、各医院、各时期统计不同,但手术机遇提高很慢。术后10a～15a生存率报道很少。术后15a～25a及以上目前国内外未见研究报道,因此本研究早期胃癌术后～30a的生存情况,以及影响它的有关因素。 1 材料和方法 1.1材料收集长海医院1974/1997早期胃癌193例。其中     

早期胃癌的临床病理特征及预后分析

目的 探讨和总结早期胃癌(early gastric cancer,EGC)的临床病理特征,并分析其与患者预后之间的关系,研究EGC淋巴转移的规律.方法 回顾性分析1990年1月-2005年12月152例EGC的临床病理资料及其对预后的影响.结果 肿瘤大小、浸润深度及淋巴转移与EGC预后相关.结论 淋巴转移是影响EGC预后的关键因素,肿瘤大小、浸润深度、分化程度是EGC淋巴转移的独立危险因子,术前对这些因素的评估有助于选择合理的治疗方案.     

25例早期胃癌临床病理分析

本院自1975年11月—1992年12月共作胃镜13756人次,经手术病理检查证实早期胃癌25例,其胃镜检出率为0.18％,早癌占胃癌总数556例的4.5％,现总结分析如下。     

早期胃癌的临床病理学研究

本文总结了我院经内镜及手术病理证实的早期胃癌53例,认为提高对早期胃癌内镜下分型的认识与鉴别水平,重视内镜普查和对癌前病变的随访,可早期发现胃癌,提高早期胃癌术后5年生存率.同时作者还对影响早期胃癌预后的因素进行了分析,认为癌浸润深度和是否有淋巴结转移是影响早期胃癌预后的主要因素.     

222例早期胃癌的临床病理及预后分析

胃癌在我国发病率高,居消化道恶性肿瘤之首。进展期胃癌治疗效果差,手术治疗5年生存率仅40％-60％。早期胃癌手术治疗后5年生存率可达90％以上,然而我国早期胃癌检出率一直较低。因此,提高早期胃癌诊断率是提高胃癌生存的关键。现将我院7年间经手术病理证实的222例早期胃癌的临床病理及随访资料进行分析,总结早期胃癌临床病理特点,以提高临床医师对早期胃癌的认识。     

早期胃癌32例临床病理分析

目的 探讨早期胃癌的临床与病理特点,提高早期胃癌的检出率,以期改善胃癌患者的预后.方法 收集2001-2005年经手术切除病理证实为早期胃癌32例患者的病历资料,分析其临床病理特点.结果 早期胃癌与某些病理特点有关.结论 提高早期胃癌的发现率,并综合分析临床症状、胃镜检查及活检结果,选择合适的治疗方案.     

早期胃癌的胃镜下特点——附78例临床分析

目的分析早期胃癌的临床病理特征,提高早期胃癌的检出率。方法总结我院2004年～2006年经术前胃镜检查及活检,后全部经手术与病理证实为早期胃癌的78例患者的临床病理特征。结果 78例早期胃癌发病高峰年龄为50-59岁,胃窦和胃角是好发部位,各30例(33.33%),病理以Ⅱc型最多,为40例(51.28%),管状腺癌最多,为54例(69.23%)。结论早期胃癌临床无特异性症状,需认真对胃镜及病理结果分析,才能提高早期胃癌的检出率。     

早期胃癌7例临床分析

目的 探讨早期胃癌的诊断及治疗。方法 分析我院1997-01／2002-08，经胃镜检查及粘膜活检病理诊断的7例早期胃癌，其中男6例，女1例，年龄30～65岁，平均52岁。胃镜检查发现粘膜表面粗糙、隆起、凹陷、糜烂、溃疡者，常规粘膜活检6块以上，活检前常规借助活检钳触诊，如有弹性下降、僵硬感、不柔软者，则粘膜活检阳性率可提高，病理诊断早期胃癌者则外科手术。结果 胃镜诊断胃角溃疡1例，胃体糜烂2例，胃窦糜烂4例，病理诊断低分化腺癌4例，未分化腺癌3例。7例术后随访10～60个月，平均30．5个月，7例均存活。结论 胃镜检查结合粘膜活检是诊断早期胃癌的最可靠的手段，手术切除是有效的方法。     

Unveiling lymph node metastasis in early gastric cancer

With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been developed.Currently,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and Japan.In the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/ESD.Generally,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC cases.However,there is some controversy among investigators regarding the validity of these criteria.Further,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic resection.The first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic findings.After endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of invasion.However,evaluation of clinical application data is essential for validating this recommendation.Moreover,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.     

浅表扩散型早期胃癌的内镜及临床特点分析

目的探讨浅表扩散型早期胃癌的内镜下形态表现及病理特征。方法收集4年间经手术病理证实的早期胃癌患者466例,其中病灶最长径≥5 cm的浅表扩散型早期胃癌患者26例,回顾性分析其临床资料、内镜下形态、手术记录及术后病理结果,并与普通型早期胃癌进行比较。结果 466例早期胃癌患者中,有26例患者为浅表扩散型,占早期胃癌患者的5.58%。其临床表现以中上腹疼痛居多(80.77%,21/26),内镜下检查病灶累及一个以上胃区者15例(57.69%),镜下形态主要为溃疡增殖型(46.15%,12/26)。手术切除胃癌标本中浅表凹陷型占38.46%,而病理上低分化型及未分化型占61.54%;胃癌灶黏膜下层浸润率及淋巴结转移率都较普通型EGC高(65.38%vs 39.77%,P<0.01;38.46%vs 12.27%,P<0.01)。结论浅表扩散型早期胃癌病灶范围广,边界不易判断;黏膜下层浸润率及淋巴结转移率较高,因此应强调术前癌灶范围的正确界定、手术中病灶的完整切除及区域淋巴结的扩大清扫。     

Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability

AIM: To investigate endoscopic and clinicopathologic characteristics of early gastric cancer (EGC) according to microsatellite instability phenotype.METHODS: Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability (MSI) mutation [high MSI (MSI-H)] and 146 consecutive EGC patients with one or no MSI mutation (non-MSI-H) were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.RESULTS: In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern (OR 4.38, 95% CI: 2.40-8.01, P < 0.001), moderate-to-severe atrophy in the surrounding mucosa (OR 1.91, 95% CI: 1.05-3.47, P = 0.033), antral location (OR 3.99, 95% CI: 2.12-7.52, P < 0.001) and synchronous lesions, compared to non-MSI-H EGCs (OR 2.65, 95% CI: 1.16-6.07, P = 0.021). Other significant clinicopathologic characteristics of MSI-H EGC included predominance of female sex (OR 2.77, 95% CI: 1.53-4.99, P < 0.001), older age (> 70 years) (OR 3.30, 95% CI: 1.57-6.92, P = 0.002), better histologic differentiation (OR 2.35, 95% CI: 1.27-4.34, P = 0.007), intestinal type by Lauren classification (OR 2.34, 95% CI: 1.15-4.76, P = 0.019), absence of a signet ring cell component (OR 2.44, 95% CI: 1.02-5.86, P = 0.046), presence of mucinous component (OR 5.06, 95% CI: 1.27-20.17, P = 0.022), moderate-to-severe lymphoid stromal reaction (OR 3.95, 95% CI: 1.59-9.80, P = 0.003), and co-existing underlying adenoma (OR 2.66, 95% CI: 1.43-4.95, P = 0.002).CONCLUSION: MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics including frequent presentation in protruded type, co-existing underlying adenoma, and synchronous lesions.     

Clinicopathological features of alpha-fetoprotein producing early gastric cancer with enteroblastic differentiation

AIMTo investigate clinicopathological features of early stage gastric cancer with enteroblastic differentiation (GCED).METHODSWe retrospectively investigated data on 6 cases of early stage GCED and 186 cases of early stage conventional gastric cancer (CGC: well or moderately differentiated adenocarcinoma) who underwent endoscopic submucosal dissection or endoscopic mucosal resection from September 2011 to February 2015 in our hospital. GCED was defined as a tumor having a primitive intestine-like structure composed of cuboidal or columnar cells with clear cytoplasm and immunohistochemical positivity for either alpha-fetoprotein, Glypican 3 or SALL4. The following were compared between GCED and CGC: age, gender, location and size of tumor, macroscopic type, ulceration, depth of invasion, lymphatic and venous invasion, positive horizontal and vertical margin, curative resection rate.RESULTSSix cases (5 males, 1 female; mean age 75.7 years; 6 lesions) of early gastric cancer with a GCED component and 186 cases (139 males, 47 females; mean age 72.7 years; 209 lesions) of early stage CGC were investigated. Mean tumor diameters were similar but rates of submucosal invasion, lymphatic invasion, venous invasion, and non-curative resection were higher in GCED than CGC (66.6% vs 11.4%, 33.3% vs 2.3%, 66.6% vs 0.4%, 83.3% vs 11% respectively, P < 0.01). Deep submucosal invasion was not revealed endoscopically or by preoperative biopsy. Histologically, in GCED the superficial mucosal layer was covered with a CGC component. The GCED component tended to exist in the deeper part of the mucosa to the submucosa by lymphatic and/or venous invasion, without severe stromal reaction. In addition, Glypican 3 was the most sensitive marker for GCED (positivity, 83.3%), immunohistochemically.CONCLUSIONEven in the early stage GCED has high malignant potential, and preoperative diagnosis is considered difficult. Endoscopists and pathologists should know the clinicopathological features of this highly malignant type of cancer.     

漏诊型同时性多发早期胃癌的临床病理特征分析

目的:探讨漏诊型同时性多发早期胃癌（synchronous multiple early gastric cancer,SMEGC）的临床病理学特征。方法:回顾性收集并分析2015年1月—2019年12月于首都医科大学附属北京友谊医院就诊的10例漏诊型SMEGC患者的临床资料,并对其临床特点、内镜表现及病理结果进行描述...     

早期胃癌的内镜下特征分析

目的探讨早期胃癌的内镜下特征。方法对2010年1月至2014年7月北京军区总医院消化科胃镜检查发现并经病理确诊的119例早期胃癌患者（130处病灶）和695例进展期胃癌患者（695处病灶）的临床资料进行回顾性总结,对比分析早期胃癌的内镜下特征。结果早期胃癌癌灶多位于胃窦部（34．6％,45／130）,镜下形态分类以0-Ⅱc型最多见（55．4％,72／130）,白光内镜下97处（74．6％）病灶可见色调发红、121处（93．1％）具有清晰的边界、46处（35．4％）边缘部有明显“毛刺征”、116处（89．2％）具有明显不规则的表面形态或颜色、35处（26．9％）表面可见并发的溃疡、57处（43．8％）可见自发性出血、108处（83．1％）周边背景黏膜有肠化／萎缩改变、23处（17．7％）表面可见白色不透明物质,病理分型以分化型为主（90．8％,118／130）;进展期胃癌癌灶多位于胃底／贲门部（39．1％,272／695）,病理分型以未分化型为主（81．3％,565／695）。两者在病变分布和病理分型构成方面差异均有统计学意义（P〈0．05）。结论清晰的边界和表面不规则是早期胃癌的重要内镜下特征,胃镜检查时重视上述特点的观察将有助于早期胃癌的发现和诊断。     

Clinicopathological features of early gastric cancer with duodenal invasion

The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management.A Medline search was performed using the keyword early gastric cancer＂ and ＂duodenal invasion＇： Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors 〉 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor.There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum.The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is 〉 60 ram, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.     

Clinical features of second primary cancers arising in early gastric cancer patients after endoscopic resection

AIM: To investigate the incidence and distribution of second primary cancers (SPCs) in early gastric cancer (EGC) patients who underwent endoscopic resection (ER), compared to advanced gastric cancer (AGC) patients who underwent surgery.METHODS: The medical records of 1021 gastric cancer (GC) patients were retrospectively reviewed from January 2006 to December 2010. The characteristics and incidence of SPCs were investigated in those with EGC that underwent curative ER (the EGC group) and those with AGC who underwent curative surgical resection (the AGC group).RESULTS: We ultimately enrolled 184 patients in the EGC group and 229 patients in the AGC group. A total of 38 of the 413 (9.2%) GC patients had SPCs; the rate was identical in both groups. Of these 38 patients, 18 had synchronous and 20 had metachronous cancers. The most common SPC was lung cancer (18.4%), followed by colorectal cancer (13.2%) and esophageal cancer (13.2%). No significant risk factors were identified for the development of SPCs.CONCLUSION: Endoscopists should provide close surveillance and establish follow-up programs to ensure SPC detection in GC patients undergoing curative resection regardless of their clinical characteristics.