弥漫浸润型和非弥漫浸润型胃印戒细胞癌的临床病理特征研究

发布时间：2019-04-15 18:34

【摘要】：目的:研究比较胃印戒细胞癌中弥漫浸润型和非弥漫浸润型的临床病理特征之间存在的差异。方法:收集浙江大学附属第一医院肿瘤外科2009年1月～2015年12月行胃癌手术的印戒细胞胃癌患者共317例,并进行回顾性分析,其中弥漫浸润型SRCC73例,占总数的23.03%,非弥漫浸润型244例,占76.97%。男192例,女125例,男女比例约为1.5:1,年龄16～83岁,中位年龄57岁。对两种类型胃印戒细胞癌的发病年龄、性别、肿瘤位置、肿瘤大小、TNM分期进行统计分析,并对有效随访的60例印戒细胞癌患者进行了 Kaplan-Meier法生存分析。统计数据主要来源于手术记录以及病理报告,随访数据来自于电话随访、门诊信息以及临床影像数据库。运用SPSS软件对相关数据进行处理和分析。结果:弥漫浸润型和非弥漫浸润型胃印戒细胞癌在发病性别(P=0.830)和年龄(p=0.360)上没有统计学意义,前者主要侵犯全胃(80.3%),仅有少数(12.7%)病变局限于远端胃,而发生在近端为和胃体的病例数更少;非弥漫浸润型的肿瘤最常见的部位为远端胃(39.6%)和胃体(34.6%),侵犯全胃的仅占12.5%,另有少数位于近端胃和贲门(p0.001)。弥漫浸润型SRCC的平均直径为10.03±3.70(cm),非弥漫浸润型SRCC的肿瘤直径约为4.40±2.88(cm),两者相比具有统计学意义(p0.001)。所有弥漫浸润型胃印戒细胞癌中,超过90%的病例已达T4期,其中70.8%已侵出浆膜外,20.8%已侵犯邻近结构;在非弥漫浸润的类型中,共有23.7%的胃印戒细胞癌病变局限于粘膜和粘膜下层,43.2%的病例达T4a期,11.6%处于T4b期(p0.001)。弥漫浸润型中处于N2期的有18.1%,处于N3期的病例占61.1%;非弥漫浸润型胃印戒细胞癌中有28.3%的患者未见淋巴结转移,N2期18.3%,而N3期仅占36.9%(p0.01)。弥漫浸润型中43.1%未累及脉管及神经,34.7%同时侵犯了神经和脉管;非弥漫浸润型中56.9%累及脉管及神经,15.1%同时侵犯了神经和脉管(p0.01)。弥漫型SRCC中位生存时间为19个月,非弥漫型SRCC中位生存时间为36个月;两者的一年生存率分别为73.3%、76.7%,三年生存率分别为20.0%、46.7%,五年生存率分别为0、36.7%,非弥漫型SRCC的预后明显优于弥漫型SRCC(P=0.004)。结论:弥漫浸润型与非弥漫浸润型SRCC在肿瘤发生部位和肿瘤大小等特征上均有很大差别,并且与非弥漫浸润型的部分早癌相比,弥漫浸润型SRCC多呈现为Ⅲ～IV期胃癌,生存分析的结果进一步证明了非弥漫浸润型SRCC的预后较弥漫浸润型更好。在弥漫浸润型SRCC中CEA和CA199水平的升高更明显,或许可以作为疾病诊断以及评价预后的一项辅助指标,。鉴于两种胃印戒细胞癌这种特征的差异,或许是因为分子学水平上的差异才导致了临床病理学特征的截然不同。
[Abstract]:Objective: to compare the clinicopathological features of diffuse infiltrating type and non-infiltrating type in signet ring cell carcinoma of stomach. Methods: a total of 317 patients with signet-ring gastric cancer who underwent gastric cancer surgery from January 2009 to December 2015 in the first affiliated Hospital of Zhejiang University were collected and analyzed retrospectively. Among them, diffuse infiltrating type SRCC73 was found in 23.03% of the total. 244 cases (76.97%) were non-diffuse infiltrative type. There were 192 males and 125 females, the ratio of male and female was about 1.5%, the age was 16 to 83 years old, the median age was 57 years old. The age, sex, tumor location, tumor size and TNM stage of two types of signet ring cell carcinoma were analyzed statistically. The survival of 60 patients with signet ring cell carcinoma was analyzed by Kaplan-Meier method. The statistical data mainly came from surgical records and pathological reports. The follow-up data came from telephone follow-up, outpatient information and clinical imaging database. SPSS software is used to process and analyze the related data. Results: there was no significant difference in sex (P < 0. 830) and age (p < 0. 360) between diffuse infiltrating and non-infiltrating signet ring cell carcinoma of stomach. The former mainly invaded the whole stomach (80.3%). Only a few (12.7%) of the lesions were confined to the distal stomach, but fewer cases occurred in the proximal part of the stomach and the body of the stomach. The most common sites of non-invasive tumors were the distal stomach (39.6%) and the gastric body (34.6%). Only 12.5% of the tumors invaded the whole stomach, and a few were located in the proximal stomach and cardia (p0.001). The average diameter of diffuse invasive SRCC was 10.03 卤3.70 (cm),. The tumor diameter of non-invasive SRCC was about 4.40 卤2.88 (cm), (p0.001). Of all cases of diffuse infiltrating signet ring cell carcinoma, more than 90% had reached T4 stage, of which 70.8% had invaded the extraserous membrane and 20.8% had invaded the adjacent structure. In all, 23.7% of gastric signet ring cell carcinoma lesions were localized in mucosa and submucosa, 43.2% of the cases reached T4a stage and 11.6% were in T4b stage (p0.001), and 23.7% of gastric signet ring cell carcinoma lesions were located in mucosa and submucosa of gastric signet ring cell carcinoma. In diffuse infiltrative type, 18.1% were in N 2 stage and 61.1% in N 3 stage. In non-invasive signet ring cell carcinoma of the stomach, 28.3% had no lymph node metastasis, 18.3% in stage N2, and 36.9% in stage N3 (p0.01). In diffuse infiltrating type, 43.1% did not involve vessels and nerves, 34.7% invaded nerves and vessels, 56.9% involved vessels and nerves in non-diffuse infiltrating type, 15.1% invaded nerves and vessels at the same time (p0.01). The median survival time of diffuse-type SRCC was 19 months and that of non-diffuse-type SRCC was 36 months. The one-year survival rate was 73.3%, 76.7%, the three-year survival rate was 20.0%, 46.7%, and the five-year survival rate was 0,36.7%, respectively. The prognosis of non-diffuse SRCC was significantly better than that of diffuse SRCC (P = 0.004). Conclusion: there are significant differences in tumor location and tumor size between diffuse invasive type and non-diffuse invasive type of SRCC. Compared with non-diffuse invasive type of partial early cancer, diffuse invasive type of SRCC mostly presents stage 鈪，

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