伴淋巴结转移的早期胃癌病理组织形态学研究

目的通过研究早期胃癌发展过程中组织形态学的变迁，预测其淋巴结转移的难易程度。方法以伴淋巴结转移的81例早期胃癌作为转移组，抽取81例不伴淋巴结转移者作为对照组，两组均含11例黏膜内癌，70例黏膜下癌，组织学分类及肿瘤部位相似，具可比性。将各组的肿瘤灶亚分类为表层部、浸润部，各病灶的病理组织形态学依据规范分为分化型、混合型、未分化型。对各病例相关因子进行统计学分析研究。结果浸润部较表层部组织分化程度低下者，转移组为40．7％，较对照组的11．9％为高。转移组表层部的分化型胃癌和未分化型胃癌，其浸润部同一组织学分化程度较对照组为低，其差异有统计学意义（分别为P〈0．01和P〈0．05）。转移组的表层部与浸润部的分化程度合致率为61．7％，明显低于对照组的77．8％，其差异有统计学意义（P〈0．05）。转移组的男女比率为1．9：1，较对照组的3．3：1为低，其差异有统计学意义（P〈0．05）。结论早期胃癌中，癌灶水平方向和浸润先端部的垂直方向组织学分化程度的变化更易出现。浸润部与黏膜同有层癌组织学分化程度不同者，尤其是组织学分化程度趋低下者易出现淋巴结转移。女性较男性更易出现淋巴结转移。

Histopathological study of early gastric cancers with lymph node metastasis

Objective To examine the ability of cancer metastasis to lymph nodes by study of the h(?)o,(?)thology of early gastric cancers. Methods Eighty-one cases of early gastric cancers with lymph node(?)etastasis were used as metastatic group. Another randomly selected 81 cases of early gastric cancer without lymph node metastasis were used as control group. Both groups consisted of 11 cases of intramucosal cancer and 70 cases of submucosal cancer. The location of cancers in tissue was further classified as two categories; the superficial lesions and invasive fronts. In addition, the gastric cancers were hislopathologically divided into three subtypes: differentiated, undifferentiated and the mixed type. The histopathological classification and location of cancers in tissue were similar between the two groups. Results In metastatic group, 40. 7% of the cancer revealed lower differentiation in invasive fronts, much higher than 11.9% in control group (P<0. 01). In the patients with differentiated or undifferentiated cancer in superficial lesions, the differentiation degree of cancer in invasive fronts was lower in metastatic group than in control group (P<0. 01 and P<0. 05 respectively). The differentiation concordance rale between superficial lesions and invasive fronts in metastatic group was 61. 7% , lower than 77. 8% in control group (P<0. 05). The male to female ratio was 1. 9:1 in metastatic group, lower than 3. 3:1 in control group (P<0.05). Conclusions In early gastric cancer, it was apt to develop different histopathological differentiation between its horizontal growth and vertical invasion. Those with different histopathological differentiation between superficial lesions and invasive fronts are apt to metastasize to lymph nodes, especially with lower differentiation. The female were easier to appear lymph node metastasis than male.