多原发早期胃癌临床病理特征及预后分析

Clinicopathologic features and prognostic analysis of multifocal early gastric cancer

目的研究多原发早期胃癌患者的临床病理特征及预后情况。方法对1983至2005年经手术证实的22例多原发早期胃癌患者的临床病理特征进行了回顾性分析,随访20例。结果多原发早期胃癌有症状者72.7%,症状无特异性,上消化道X线气钡双重造影检查阳性率75.0%,大便潜血阳性率6.3%,血清CEA阳性率0;22例总共55个病灶,胃镜漏诊6个病灶,漏诊率10.9%(6/55),Ⅱ型5个(Ⅱa+Ⅱc型1个,Ⅱa型1个,Ⅱb型3个),≤1 cm癌4个;主副癌灶间距离≥2 cm的6例6灶,占副癌灶数的18.2%(6/33),胃镜检查漏诊其中4个副癌灶,占66.7%(4/6);72.7%(16/22)的患者、76.4%(42/55)的癌灶为黏膜癌;多原发早期胃癌淋巴结转移率为5%,术后5年复发率5.1%,5年生存率94.9%;术后非胃异时癌发生率20.0%,中位间隔时间7.5年。结论多原发早期胃癌病灶多距离较近,易通过手术被切除,术后要警惕非胃异时癌,胃镜易漏诊距离较远的平坦型小胃癌。

Objective To study the clinicopathologic features and prognosis of the patients with muhifocal early gastric cancer（EGC）. Methods Twenty-two patients with multifocal EGC treated surgically from 1983 to 2005 were analyzed retrospectively. Twenty patients were followed up. Results Of the 22 muhifocal EGC patients, 72. 7% had symptoms. The clinical presentation was aspecific. The positive rate of double-contrast barium upper gastrointestinal radiography was 75.0%. The positive rate of fecal occult blood test was 6. 3%. The positive rate of serum CEA was 0. There were 55 lesions in 22 patients. The rate of endoscopic missed diagnosis was 10. 9% （6/55）. Of these 6 lesions, type- Ⅱ lesions were 5, including 1 type- Ⅱ a ＋ Ⅱ c lesion, 1 type-Ⅱ a lesion and 3 type- Ⅱb lesions. The size of 4 lesions was 1 cm or less. The distance between accessory lesion and main tumor was 2cm or more in 6 patients with 6 （ 18. 2% ,6/33 ）accessory lesions, of which 4 （ 66. 7 % ,4/6 ） were missed by endoscopy. 72. 7 % （ 16/22 ） patients and 76.4 % （42/55） lesions were mucosal cancers. Lymph node metastasis rate was 5. 0%. Postoperative 5-year recurrent rate was 5.1% and 5-year survival rate was 94.9%. Postoperative metachronous cancer rate was 20.0%. The median intervals were 7.5 years. Conclusion Major accessory lesions are located near the main tumor in multifocal EGC patients and usually can be resected by operation. Attention should always be paid to the possibility of metachronous primary carcinoma in other organs after operation. Endoscopy is prone to miss flat small accessory carcinoma far from main tumor.