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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (6): 1093-1097. doi: 10.19723/j.issn.1671-167X.2020.06.017

• 论著 • 上一篇    下一篇

早期胃癌淋巴结转移规律及内镜黏膜下剥离术治疗早期胃癌的疗效评价

武颖超1,蔡云龙2,戎龙2,张继新3,刘金1,汪欣1,△()   

  1. 1. 北京大学第一医院普通外科,北京 100034
    2. 北京大学第一医院内镜中心,北京 100034
    3. 北京大学第一医院病理科,北京 100034
  • 收稿日期:2020-05-20 出版日期:2020-12-18 发布日期:2020-12-13
  • 通讯作者: 汪欣 E-mail:wangxin_guo@hotmail.com

Characteristics of lymph node metastasis and evaluating the efficacy of endoscopic submucosal dissection in early gastric cancer

Ying-chao WU1,Yun-long CAI2,Long RONG2,Ji-xin ZHANG3,Jin LIU1,Xin WANG1,△()   

  1. 1. Department of General Surgery, Peking University First Hospital, Beijing 100034, China
    2. Department of Endoscopy, Peking University First Hospital, Beijing 100034, China
    3. Department of Pathology, Peking University First Hospital, Beijing 100034, China
  • Received:2020-05-20 Online:2020-12-18 Published:2020-12-13
  • Contact: Xin WANG E-mail:wangxin_guo@hotmail.com

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摘要：

目的:探讨早期胃癌淋巴结转移的规律,并通过与手术治疗对比评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌的疗效。方法: 回顾性分析北京大学第一医院2010年1月至2017年12月间收治的320例早期胃癌患者的临床病理资料,其中外科手术治疗198例,ESD治疗122例。分析早期胃癌的淋巴结转移规律,总结符合ESD绝对及扩大适应证的早期胃癌的淋巴结转移情况;进一步比较ESD和手术治疗早期胃癌的远期疗效,从而评价目前ESD治疗早期胃癌的绝对适应证和扩大适应证的合理性。结果:198例早期胃癌患者共有22例淋巴结转移,转移率为11.1%。单因素分析结果显示肿瘤大小(χ2=5.525,P=0.019)、浸润深度(χ2=8.235,P=0.004)、分化程度(χ2=6.323,P=0.012)、脉管浸润(χ2=12.273,P<0.001)与早期胃癌的淋巴结转移有关;多因素分析显示肿瘤浸润深度(Wald=7.575,P=0.006)和分化程度(Wald=6.317,P=0.012)是早期胃癌发生淋巴结转移的独立影响因素。符合ESD绝对适应证和扩大适应证的患者的淋巴结转移率均为0%;符合ESD绝对适应证而行手术和ESD治疗的患者的5年生存率分别为97.6%和97.9%,差异无统计学意义(χ2=0.014,P=0.907);符合ESD扩大适应证而行手术和ESD治疗的患者的5年生存率分别为96.5%和91.7%,差异无统计学意义(χ2=1.061,P=0.303)。结论: 早期胃癌的淋巴结转移主要与肿瘤的浸润深度和分化程度密切相关;本组数据显示ESD治疗早期胃癌无论是绝对适应证还是扩大适应证都跟手术疗效相当,但仍需大样本量的研究证实。

关键词: 胃肿瘤, 早期, 淋巴转移, 内镜黏膜下剥离术

Abstract:

Objective: To investigate the correlation between clinicopathological features and lymph node metastasis, and to evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) by comparing with surgery treatment. Methods: The clinicopathological data of 320 patients with EGC who were treated in Peking University First Hospital between January 2010 and December 2017 were retrospectively reviewed, in which there were 198 cases of surgical procedure and 122 cases of ESD. Characteristics of lymph node metastasis in EGC were analyzed, and lymph node metastasis of EGC with ESD absolute and expanded indications were summarized. The long-term efficacy of ESD and surgical treatment of EGC were compared to evaluate the rationality of absolute and expanded indications of ESD. Results: Lymph node metastasis was detected in 22 (11.1%) of 198 patients. Univariate analysis showed a positive relationship between tumor size (χ2=5.525, P=0.019), depth of invasion(χ2=8.235, P=0.004), histological type (χ2=6.323, P=0.012), lymphovascular invasion (χ2=12.273, P<0.001) and lymph node metastasis in EGC. Multivariate analysis revealed that depth of invasion(Wald=7.575, P=0.006) and histological type (Wald=6.317, P=0.012) were independent relative factors of lymph node metastasis in EGC. The lymph node metastasis rates of the patients with absolute and expanded ESD indications were both 0%. The 5-year survival rates of the patients who met ESD absolute indication receiving surgery treatment and ESD were 97.6% and 97.9% respectively, and the difference between the two groups was not statistically significant(χ2=0.014, P=0.907).The 5-year survival rates of the patients who met ESD expanded indication receiving surgery treatment and ESD were 96.5% and 91.7% respectively, the difference between the two groups was not statistically significant(χ2=1.061, P=0.303). Conclusion: Lymph node metastasis in EGC is mainly correlated with depth of invasion and histological type. Our data indicate that ESD procedure for EGC is comparable to surgery in terms of long-term efficacy in both absolute and expanded indications. However, some studies of a large sample size are still needed for more confirmation.

Key words: Stomach neoplasms, early, Lymphatic metastasis, Endoscopic submucosal dissection

中图分类号: 

  • R735.2

表1

影响早期胃癌患者淋巴结转移的临床病理单因素分析"

Variable n Lymph node metastasis rate/% χ2 P
Gender 0.108 0.743
Male 138 11.6
Female 60 10.0
Age/years 0.650 0.420
≤60 92 13.0
>60 106 9.4
Tumor location 1.354 0.508
Upper 1/3 24 8.3
Middle 1/3 22 18.2
Lower 1/3 152 10.5
Tumor size/cm 5.525 0.019
≤2 126 7.1
>2 72 18.1
Macroscopic type 2.920 0.232
Protruded 14 7.1
Flat 83 7.2
Ulcerative 101 14.9
Operation 0.549 0.760
Proximal gastrectomy 4 0
Distal gastrectomy 153 11.1
Total gastrectomy 41 12.2
Lymph node dissection 1.737 0.188
D1 or D1+ 27 3.7
D2 or D2+ 171 12.3
Invasive depth 8.235 0.004
Mucosa 93 4.3
Submucosa 105 17.1
Differentiated degree 6.323 0.012
Differentiated 95 5.3
Undifferentiated 103 16.5
Perineural invasion 0.797 0.372
No 194 10.8
Yes 4 25.0
Lymphovascular invasion 12.273 0.000
No 182 8.8
Yes 16 37.5

表2

影响早期胃癌患者淋巴结转移的多因素分析"

Variable B S.E. Wald df P Exp(B) 95%CI
Invasive depth 1.619 0.588 7.575 1 0.006 5.047 1.594-15.983
Differentiated degree 1.379 0.549 6.317 1 0.012 3.970 1.355-11.636

图1

符合ESD绝对适应证手术组与ESD组患者的生存比较"

图2

符合ESD扩大适应证手术组与ESD组患者的生存比较"

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