早期胃癌淋巴结转移规律及内镜切除指征的探讨

目的探讨不同组织学类型早期胃癌的淋巴结转移情况及内镜下治疗的可行性。方法回顾性分析524例行胃癌根治术治疗并经病理确诊的早期胃癌患者的病例资料，比较不同组织学类型早期胃癌的临床病理特征并对其与淋巴结转移的相关性进行单因素及多因素分析。结果印戒细胞癌与分化型腺癌、低分化腺癌相比，在肿瘤大小（P值分别为0．048和0．023）和浸润深度（P值均为0．000）方面差异均有统计学意义，其淋巴结转移率（9．7％，11／113）明显低于低分化型腺癌（22．2％，20／90），差异有统计学意义（P=0．018），但与分化型腺癌（13．t％，42／321）比较差异无统计学意义（P=0．406）。单因素分析显示肿瘤大小（P=0．007）、浸润深度（P=0．000）、组织学类型（P=0．030）、淋巴管肿瘤浸润（P=0．000）和有无溃疡（P=0．002）与淋巴结转移显著相关；多因素分析结果显示浸润深度（P=0．007）、肿瘤大小（P=0．010）、组织学分型（P=0．000）和淋巴管肿瘤浸润（P=0．000）为淋巴结转移的独立危险因素。联合上述4个独立危险因素分析显示肿瘤直径小于2cm且无淋巴管肿瘤浸润的印戒细胞型黏膜内癌未见淋巴结转移。结论印戒细胞型早期胃癌的临床病理特征与分化型和低分化型早期腺癌存在差异，直径小于2cm且无淋巴管肿瘤浸润的印戒细胞型黏膜内癌患者可行内镜切除术。

Characeristics of lymph node metastasis in early gastric cancer and feasibility of endoscopic resection

Objective To compare the clinicopathologic features of different types of early gastric cancer （ EGC）, and to investigate the risk factors of lymph node metastasis （LNM） and to explore the possi- bility of endospic resection（ER）. Methods The clinical data of the 524 EGC patients who underwent a curative gastrostomy between January 2000 and May 2011 in the hospital were analyzed, retrospectively. Clinieopathologic features were compared between different histological types and investigated by univariate and multivariate analysis for their possible relationship with LNM. Results Tumor size and depth of tumor invasion for signet ring cell cancers were significantly different from differentiated cancers and poorly differen- tiated cancers. The incidence of LNM for signet ring cell carcinoma was lower than poorly differentiated car- cinoma （9. 7% vs. 22. 2% ,P 〈 0. 05）, but not significantly different compared to differentiated cancers （ 13.1% ,42/321, P =0. 406）. Tumor size （P =0. 007）, depth of tumor invasion （P =0. 000）, histologi- cal ~ type （ P = 0. 030 ） , lymphatic involvement （ P = 0. 000 ） and ulceration （ P = 0. 002 ） showed positive correlations with LNM by univariate analysis. Multivariate analysis revealed that depth of tumor invasion （ P = 0. 007 ）, tumor size （ P = 0. 010 ）, histological type （ P = 0. 000 ）, and lymphatic involvement （ P = 0. 000） were independent risk factors of LNM. In signet ring cell carcinoma with mucosal invasion andwithout lympatic involvement, which were less than 2 cm in tumor diameter, no LNM was detected. Conclusion Early signet ring cell cacinoma has different clinicopathologic features from differentiated carci- noma and poorly differentiated carcinoma. We propose early signet ring intramucosal EGC 2 cm or less in size without lymphatic involvement can be performed by ER.