早期胃癌样5型进展期胃癌的形态及生物学特点

Morpholocial and biological features of type 5 advanced gastric cancer mimicking early gastric cancer

目的分析早期胃癌样5型进展期胃癌(5型胃癌)的临床及生物学特征。方法对手术确诊的398例胃癌中符合5型胃癌的17例患者,分析其内镜与大体标本形态学、组织病理学结果。结果17例5型胃癌占同期胃癌总数的4.3%,占进展期胃癌的5.3%,所有患者均行根治手术。形态学分类显示本组中Ⅱc型比例最高(8/17,47.0%),其次为Ⅱa+Ⅱc型(7/17,41.2%)及Ⅱc+Ⅲ型(2/17,11.8%),Ⅱa+Ⅱc型在5型进展期胃癌中所占比例较早期胃癌中高(P<0.05)。该组中分化型癌8例,未分化型9例,与同期早期胃癌相比分化程度未见明显差异,女性患者分化程度较男性患者差(P<0.01)。5例患者(29.4%)伴淋巴结及周围脏器转移,转移发生率较同期早期胃癌为高。结论5型胃癌形态学及病理学特征均不同于传统意义的进展期癌与早期胃癌,内镜检查中仔细评估病灶蠕动及伸展性、超声内镜、钡餐及螺旋CT检查可能有助于鉴别5型进展期胃癌与早期胃癌,提高术前诊断准确性。

Objective To evaluate the morphological and biological features of advanced gastric cancer grossly mimicking early gastric cancer （type 5 gastric cancer）. Methods Three hundred and ninety-eight consecutive patients with surgically confirmed gastric cancer were screened, and 17 cases of type 5 gastric cancer were confirmed. Endoscopic and macroscopic morphological features and histopathological characteristics were investigated. Results Type 5 gastric cancer accounted for 4.3% of total gastric cancer and 5.3% of advanced gastric cancer. All of them underwent radical gastrectomy. In the morphological study, eight （47.0%） , seven （41.2%） and two （11.8%） lesions showed the superficial depressed type （Ⅱe） , superficial elevated and superficial depressed type （ Ⅱa ＋Ⅱc） , superficial depressed and excavated type （ Ⅱc ＋ Ⅲ） , respectively. Type Ⅱ a ＋ Ⅱc was more frequently observed in type 5 advanced gastric cancer than in early gastric cancer （P 〈 0.05）. In terms of tumor differentiation, eight cases were differentiated and nine undifferentiated, with undifferentiated cancer more commonly found in female than in male patients （ P 〈 0.01 ）. Lymph node metastases were detected in four cases and metastasis to duodenum in one, with a total metastatic incidence of 29.4% , which was much higher than that in the early gastric cancer. Conclusion Type 5 advanced gastric cancer differs from either Borrmann type advanced cancer or early gastric cancer in morphology as well as histopathology. Careful evaluation of rigidity of the lesion under endoscopy, endoscopic ultrasound （EUS） , barium study and multidetector CT （MDCT） may offer benefits to differentiate early cancers from type 5 gastric cancers and increase the accuracy of pre-surgical evaluation.