基于2010版WHO标准国人早期近端胃癌的临床病理学特点研究
发布时间：2019-07-08 18:35
【摘要】：背景:国人早期胃癌(EGC),尤其是早期近端胃癌(PGC)的流行病学、病理学特点,淋巴结转移危险因素及相应内镜治疗策略尚不完全明确。AJCC指南将近端胃癌归类为胃食管交界部肿瘤,并建议按食管下段腺癌进行分期。而这一标准未必适合国人近端胃癌患者。目的:比较早期近端胃癌和远端胃癌(DGC)在流行病学、病理学、淋巴结转移率及内镜表现方面的差异,进一步寻找国人近端胃癌不等同于胃食管交界部肿瘤的依据。方法:对从2005-2012年在我院进行治疗的438例早期胃癌标本根据2010版WHO标准重新阅片,包括131例PGC和307例DGC病例,并进行随访。中位随访时间为55个月(2-107个月)。通过Logistic回归分析明确EGC的流行病学危险因素,淋巴结转移危险因素。卡方检验和COX回归分析寻找与早癌预后相关的临床病理学因素。通过对独立危险因素进行赋值,从而对早癌患者术前发生淋巴结转移的危险性进行评估,以指导治疗策略的选择。结果:流行病学结果显示,PGC占全部EGC的比例近年来呈现明显上升的趋势(P0.05),其特有的独立危险因素包括高龄(60岁),个人肿瘤病史,高体质量指数(24),以及有环境毒物接触史。全部EGC患者5年存活率为92.9%,PGC患者术后随访的存活时间为42.4个月,略短于DGC(48.3个月)。在内镜下,61.9%的PGC表现为以隆起型(I)或浅表隆起型(Ⅱa)病变为主,而浅表凹陷型(Ⅱc)和溃疡型(ⅡI)则仅占33.6%,较DGC有明显不同,后者分别占32.6%和64.5%。PGC病灶平均直径较DGC更小(平均1.9cm vs.2.2cm,P0.05),病灶侵犯至粘膜下深层(SM2)的比例较DGC更高(22.9%vs.13.0%,P0.05),但淋巴结转移更为少见(2.9%vs.16.7%,P0.05)。在病理类型方面,PGC较DGC表现出明显的异质性。其中乳头状腺癌(32.1%vs.12.1%,P0.05),及其它少见类型如粘液癌、神经内分泌癌和髓样癌伴淋巴样间质的比例(6.9%vs.1.6%,P0.05)较DGC更为多见,而低粘附性癌的比例则更低(5.3%vs.35.8%,P0.05)。乳头状、微乳头状腺癌和淋巴结转移是导致早癌患者不良预后的独立危险因素。导致淋巴结转移的独立危险因素包括女性,DGC,低粘附性癌和脉管侵犯。我们基于以上四个独立危险因素提出了一个满分为15分的淋巴结转移危险度评分体系。可将患者分为低危(0-3分),高危(4-7分)和极高危(≥8分)三组。其对高危以上患者鉴别的敏感性为94%,特异性为60%。结论:近端胃癌的流行病学危险因素与远端食管腺癌、远端胃癌存在差异,在病理特点上也存在异质性,其结果支持国人胃食管交界部肿瘤起源于近端胃,而非远端食管。相比于远端早癌,近端胃早癌体积小,淋巴结转移率低,更适合行内镜治疗。我们提出的15分评分体系可助于早癌患者治疗策略的选择。
[Abstract]:Background: the epidemiological, pathological characteristics, risk factors of lymph node metastasis and endoscopic treatment strategy of early gastric cancer (EGC), especially early proximal gastric cancer, are not completely clear. AJCC guidelines classify proximal gastric cancer as gastroesophageal junction tumor, and suggest staging according to the lower esophageal carcinoma. This standard may not be suitable for Chinese patients with proximal gastric cancer. Objective: to compare the epidemiological, pathological, lymph node metastasis rate and endoscopic findings of early proximal gastric cancer and distal gastric cancer (DGC), and to find out the basis that proximal gastric cancer is not equal to gastroesophageal junction tumor in Chinese. Methods: 438 cases of early gastric cancer treated in our hospital from 2005 to 2012 were reread according to the WHO standard of version 2010, including PGC and DGC, and were followed up. The median follow-up time was 55 months (2 鈮，
本文编号：2511791
[Abstract]:Background: the epidemiological, pathological characteristics, risk factors of lymph node metastasis and endoscopic treatment strategy of early gastric cancer (EGC), especially early proximal gastric cancer, are not completely clear. AJCC guidelines classify proximal gastric cancer as gastroesophageal junction tumor, and suggest staging according to the lower esophageal carcinoma. This standard may not be suitable for Chinese patients with proximal gastric cancer. Objective: to compare the epidemiological, pathological, lymph node metastasis rate and endoscopic findings of early proximal gastric cancer and distal gastric cancer (DGC), and to find out the basis that proximal gastric cancer is not equal to gastroesophageal junction tumor in Chinese. Methods: 438 cases of early gastric cancer treated in our hospital from 2005 to 2012 were reread according to the WHO standard of version 2010, including PGC and DGC, and were followed up. The median follow-up time was 55 months (2 鈮，
本文编号：2511791
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