老年未分化型早期胃癌淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in elderly patients with undifferentiated early gastric cancer

目的总结老年患者未分化型早期胃癌(early gastric cancers,EGCs)的临床病理特征,分析未分化型EGCs淋巴结转移的危险因素。方法纳入2010年1月—2019年8月在北京协和医院行根治性胃癌切除+淋巴结清扫术,手术病理诊断符合EGCs的老年(≥65岁)患者,以分化型EGCs为对照,比较分析未分化型EGCs(即印戒细胞癌和低分化腺癌)的临床病理特征。用Logistic回归对老年未分化型EGCs淋巴结转移风险进行多因素分析。结果纳入老年EGCs共165例,其中未分化型EGCs 82例(印戒细胞癌11例,低分化腺癌71例),分化型EGCs 83例。淋巴结转移率方面,老年EGCs淋巴结转移率为9.1%(15/165),分化型EGCs淋巴结转移率为4.8%(4/83),未分化型EGCs淋巴结转移率为13.4%(11/82)。未分化型EGCs中,低分化腺癌淋巴结转移率为15.5%(11/71),印戒细胞癌11例均无淋巴结转移。单因素分析提示浸润深度(P=0.019)、病变大小(P=0.006)、合并溃疡(P=0.006)、凹陷型(P=0.003)与老年未分化型EGCs淋巴结转移相关。多因素分析提示黏膜下层浸润(OR=11.98,95%CI:1.17~122.84,P=0.037)、病变直径>2 cm(OR=11.95,95%CI:1.88~76.07,P=0.009)是老年未分化型EGCs淋巴结转移的独立危险因素。所有满足扩大适应证的老年未分化型EGCs无淋巴结转移。结论黏膜下层浸润、病变直径>2 cm是老年未分化型EGCs淋巴结转移的独立危险因素。满足扩大适应证的老年未分化型EGCs患者适合内镜黏膜下剥离术治疗。

Objective To investigate the clinicopathological characteristics and the risk factors of lymph node metastasis(LNM)of undifferentiated early gastric cancers(EGCs)in elderly patients.Methods The elderly patients(≥65 years old)who underwent radical gastrectomy with lymph node dissection and were diagnosed as having EGCs in Peking Union Medical College Hospital from January 2010 to August 2019 were included.The clinicopathological characteristics of undifferentiated EGCs(namely signet ring cell EGCs and poorly differentiated EGCs)were compared with those of differentiated EGCs,and the risk factors for LNM of undifferentiated EGCs in the elderly patients were analyzed with logistic regression.Results Data of 165 elderly EGCs patients were reviewed,including 82 undifferentiated EGCs(11 signet ring cell and 71 poorly differentiated)and 83 differentiated EGCs.The overall LNM incidence was 9.1%(15/165)in elderly EGCs patients,4.8%(4/83)and 13.4%(11/82)in differentiated and undifferentiated EGCs,respectively.Of all undifferentiated EGCs,the LNM incidence in poorly differentiated EGCs was 15.5%(11/71),and none of 11 signet ring cell EGCs had LNM.Depth of tumor invasion(P=0.019),tumor size(P=0.006),combination of ulceration(P=0.006),depressed gross type(P=0.003)were found to be associated with LNM in elderly undifferentiated EGCs patients under univariate analysis.Multivariate analysis revealed that submucosal invasion(OR=11.98,95%CI:1.17-122.84,P=0.037)and tumor size>2 cm(OR=11.95,95%CI:1.88-76.07,P=0.009)were independent risk factors for LNM in elderly undifferentiated EGCs patients.All elderly undifferentiated EGCs patients who met the criteria for expanded indications had no LNM.Conclusion Submucosal invasion and tumor size>2 cm are independent risk factors for LNM in elderly undifferentiated EGCs patients.The elderly EGCs patients who met the criteria for expanded indications are suitable for endoscopic submucosal dissection.