158例早期胃癌病理特征分析

Pathological Characteristics of Early Gastric Cancer: an Analysis of 158 Cases

目的:研究158例早期胃癌的病理特征及临床意义。方法:回顾分析1972年1月～2003年12月福建医科大学附属协和医院检查2792例胃癌根治术标本,其中158例早期胃癌行根治术标本的肿瘤直径、浸润深度、肉眼分果型:全、组组织男学12分3例型,、女淋巴35结例数;1目00、例淋(巴63结.2转9%移)进肿行瘤检局查限,在其粘中膜随内机,选58取例1侵5例及进粘行膜I下d1;及发P生C部NA位免主疫要组位织于化胃学小分弯析9。7例结(61.39%);肉眼分型以Ⅱ型为主(94例,60.26%);组织学类型以管状腺癌为主(127例,80.38%);出现淋巴结转移12例(7.59%),其中粘膜内癌5例(3.16%),粘膜下癌7例(4.43%);肿瘤位于粘膜内组平均淋巴结12.37个,肿瘤位于粘膜下组平均淋巴结17.31个,差别有统计学意义(P<0.05)。12例早期胃癌合并淋巴结转移的患者,转移淋巴结位于粘膜内组与粘膜下组比较,经两独立样本t检验差别有统计学意义(P<0.05)。完整随访43例早期胃癌患者,出现淋巴结转移者平均生存7.42年,无淋巴结转移者平均生存8.59年。15例经免疫组织化学分析Id1及PCNA均呈高表达,染色阳性评分明显高于正常对照组(P<0.005)。结论:本组早期胃癌患者男性多于女性,年龄31～60岁,随着肿P瘤C向NA粘关检膜键测下词证层实发早早展期期,胃胃病癌癌灶同下临样淋床具巴病有结理侵数袭目术与随后增之生殖增存的多恶;生性存生期物学与特淋点巴。结转移个数、浸润深度未见明显相关性。经Id1与PCNA检测证实早期胃癌同样具有侵袭与增殖的恶性生物学特点。

Objective： To investigate the pathological characteristics of 158 cases of early gastric cancer and the related clinical significance. Methods： From January 1972 to December 2003, we examined 2,792 specimens of stomach cancer obtained through radical gastrectomy. Among those there were 158 samples from patients with early gastric cancer. Tumor diameter, depth of invasion, histological type, number of lymph node dissection and lymph node metastases were analyzed. Another randomly selected 15 cases of early gastric cancer underwent immunohistochemical analysis with Ⅰ d1 and PCNA antibodies. Results： There were 123 males and 35 females. The cancer was limited to mucosa in 100 cases （63.29%） and invaded into submucosa in 58 cases （36.71%）. Early gastric cancer was mainly located in lesser curvature of stomach （61.39%）, and was mainly types Ⅱ （59.49%） in gross pathology and tubular adenocarcinoma （80.38%） in histopathology. The incidence of lymph node metastases was 7.59% （12 of 158）, with 3.16% （5 of 158） in mucosal cancer and 4.43% （7 of 158） in submucosal cancer. The number of lymph nodes with metastasis was 12.37 in the mucosal cancer group and 17.31 in the submucosal cancer group, with a significant statistical significance （P〈0.05）. The number of dissected lymph nodes was 1,204 in the 100 cases of mucosal cancer and 1,003 in the 58 cases of submucosal cancer, with a significant difference （P〈0.01）. There were 43 cases （27.21%） who completed the follow up. No significant difference was found in postoperative survival between the patients with metastatic lymph nodes （median 7.37 years ） and patients without metastatic lymph nodes（median 8.59 years ） （P〉 0.05）. The expression of Ⅰd1 and PCNA was stronger in gastric cancer than in the normal control group （P〈 0.05）. Conclusion： In cases of early gastric cancer in this study, there were more males. Metastasis did not affect the postoperative survival. The malignant biological character of early gastric cancer was proven by strong expression of Ⅰd1 and PCNA.