分化型早期胃癌中肠母细胞表型的淋巴结转移危险度及其与内镜切除术适应标准的关系

Analysis of risk factors for lymph node metastasis of enteroblastic phenotype in differentiated early gastric cancer and its relationship with adaptation criteria for endoscopic resection

目的探讨分化型早期胃癌中肠母细胞表型的淋巴结转移危险度及其与内镜切除术适应标准的关系。方法收集经手术切除的分化型早期胃腺癌200例,采用免疫组化EnVision法检测肠母细胞标志物SALL4、GPC3及AFP,观察具有肠母细胞表型分化型早期胃癌的临床病理特征,分析其与淋巴结转移及内镜切除术适应标准的关系。结果200例分化型早期胃腺癌中有21例具有肠母细胞表型,占10.5%(21/200),其中13例为肠母细胞表型,8例为部分肠母细胞表型。具有肠母细胞表型患者的淋巴结转移率(76.2%,16/21)高于非肠母细胞表型者(12.8%,23/179),其HER-2(3+)及(2+)的阳性率也较高。具有肠母细胞表型、淋巴管侵犯及HER-2过表达是淋巴结转移的独立风险因素(P均<0.05)。4例符合扩展内镜切除标准并发生淋巴结转移的病例中有3例具有肠母细胞表型。结论部分分化型早期胃腺癌具有肠母细胞表型,其是淋巴结转移的独立危险因素,建议采取更严格的临床措施或评估标准,避免因内镜治疗所带来的临床风险。

Purpose To investigate the risk of lymph node metastasis of the enteroblastic phenotype in differentiated early gastric cancer and its relationship with the standard of endoscopic resection.Methods 200 cases of early differentiated gastric adenocarcinoma resected were collected.The enteroblastic phenotype markers SALL4,GPC3 and AFP were detected by immunohistochemical EnVision method,the clinicopathological characteristics of early differentiated gastric cancer with the enteroblastic phenotype were observed,and the relationship between the enteroblastic phenotype and the lymph node metastasis and the standard of endoscopic resection was analyzed.Results Among the 200 cases of early differentiated gastric cancer,21 cases had the enteroblastic phenotype,accounting for 10.5%(21/200),of which 13 cases had the enteroblastic phenotype,8 cases had partial enteroblastic phenotype.The positive rate of lymph node metastasis of patients with enteroblastic phenotype(76.2%,16/21)was higher than that of non-enteroblastic phenotype(12.8%,23/179).The rates of HER-23+and 2+expression in patients with enteroblastic phenotype were also higher.Multivariate regression analysis showed that the enteroblastic phenotype,lymphatic invasion and HER-2 overexpression were independent risk factors for lymph node metastasis(all P<0.05).Of the 4 cases that met the criteria for extended endoscopic resection and had lymph node metastasis,3 cases had the enteroblastic phenotype.Conclusion Some differentiated early gastric adenocarcinoma have the enteroblastic phenotype,which is an independent risk factor for lymph node metastasis.For such cases,it is recommended to adopt more stringent clinical measures or evaluation criteria to avoid the clinical risks caused by endoscopic treatment.