未分化型早期胃癌的淋巴结转移规律分析

The clinicopathological features of lymph node metastasis in undifferentiated early gastric cancer

目的探讨未分化型早期胃癌(EGC)的淋巴结转移规律。方法对1994年1月至2008年12月手术治疗的335例早期胃癌的临床病理学资料进行回顾性分析。结果未分化型早期胃癌的淋巴结转移率为17.9%,其中黏膜内癌(M癌)和黏膜下层癌(SM癌)的淋巴结转移率分别为10.5%、25.6%,直径≤2.0cm和>2.0cm的淋巴结转移率分别为8.0%和25.8%,脉管瘤栓阳性和脉管瘤栓阴性的淋巴结转移率为50.0%和16.3%。单因素分析显示,肿瘤大小、浸润深度、脉管瘤栓与未分化型早期胃癌淋巴结转移相关(P<0.05)。多因素分析显示,肿瘤最大径>2cm、黏膜下层浸润和脉管瘤栓是未分化型早期胃癌淋巴结转移的独立危险因素(P<0.05)。结论肿瘤直径≤2cm、黏膜内癌、无脉管瘤栓的未分化型早期胃癌发生淋巴结转移风险小。

Objective To analyze the clinicopathological features of lymph node metastasis in un- differentiated early gastric cancer （EGC）. Methods The clinicopathological data of 335 EGC cases from Jan 1994 to Dec 2008 undergone resection were analyzed retrospectively. Results The rate of lymph node metastasis in undifferentiated EGC was 17.9% ,in submucosal tumors 25.6% ,which was significantly higher than that in mucosal tumors （ 10. 5% ）. Lymph node metastasis was 8.0% in the size of undifferentiated ear- ly gastric cancer ~〈 2. 0cm,25.8% in patients with carcinoma 〉 2. 0cm. Lymph node metastasis was found in 50.0% cases with vascular involvement and in 16. 3% cases without vascular involvement. The tumor size, depth of tumor invasion, vascular involvement showed a positive correlation with lymph node metastasis in undifferentiated EGC by univariate analysis （ P 〈 0.05）. Multivariate analysis revealed that tumor size 〉 2cm, submucosal invasion, histological type and vascular involvement were identified as independent risk fac- tors of lymph node metastasis （P 〈 0. 05）. Conclusions The risk of lymphatic metastasis of undifferentiat- ed EGC was smaller in those with tumor size ~〈2cm, intramucosal tumors,and without vascular involvement.