Background

Whether early gastric cancer with mixed histologic type should be considered for endoscopic submucosal dissection (ESD) remains controversial. The objective of this study was to evaluate the risk of lymph node metastasis (LNM) and prognostic significance for early gastric cancer with mixed histologic type.

Methods

We retrospectively reviewed clinicopathologic and survival data of 302 patients who underwent surgical resection for early gastric cancer. Based on the histologic components, all patients were classified as pure differentiated type, pure undifferentiated type and mixed histologic type. The prognostic differences between different types were compared and predictive factors for LNM were evaluated.

Results

Histopathologically, the proportion of mixed histologic type was 12.3% in early gastric cancer. In terms of LNM, mixed histologic type had a more frequent incidence than pure differentiated type (32.4% vs 11.1%, P < 0.01). However, there was no significant difference between mixed type and pure undifferentiated type for LNM (32.4% vs 21.1%, P = 0.139). Multivariate analysis revealed that tumor size >2 cm (odds ratio [OR]: 2.153, 95% confidence interval [CI]: 1.113-4.164, P < 0.05), submucosal invasion (OR: 3.881, 95%CI: 1.832-8.222, P < 0.001), lymphovascular invasion (OR: 8.797, 95% CI: 2.643-29.277, P < 0.001), undifferentiated type (OR: 3.146, 95% CI: 1.352-7.320, P < 0.01), and mixed histologic type (OR: 3.635, 95% CI: 1.272-10.390, P < 0.05) were independent risk factors for LNM in early gastric cancer patients. However, mixed histologic type did not affect the survival outcome of these patients (hazard ratio: 0.629, 95% CI: 0.074-5.311, P > 0.05).

Conclusion

Mixed histologic type was an independent risk factor for lymph node metastasis in early gastric cancer patients. The decisions regarding endoscopic submucosal dissection for mixed histologic type should be carefully considered.

中文翻译：

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混合组织学类型早期胃癌患者淋巴结转移的风险和预后结果。

背景

是否应考虑进行内镜黏膜下剥离术 (ESD) 的混合组织学类型的早期胃癌仍存在争议。本研究的目的是评估淋巴结转移（LNM）的风险和早期混合组织学类型胃癌的预后意义。

方法

我们回顾性地审查了 302 例早期胃癌手术切除患者的临床病理和生存数据。根据组织学成分，将所有患者分为纯分化型、纯未分化型和混合型。比较不同类型之间的预后差异并评估 LNM 的预测因素。

结果

组织病理学上，早期胃癌混合组织类型的比例为12.3%。就 LNM 而言，混合组织学类型的发病率高于纯分化类型（32.4% vs 11.1%，P < 0.01）。然而，LNM 的混合型和纯未分化型之间没有显着差异（32.4% vs 21.1%，P  = 0.139）。多变量分析显示肿瘤大小 >2 cm（优势比 [OR]：2.153，95% 置信区间 [CI]：1.113-4.164，P < 0.05），粘膜下浸润（OR：3.881，95%CI：1.832-8.222，P < 0.001），淋巴血管侵犯（OR：8.797，95% CI：2.643-29.277，P < 0.001），未分化型（OR：3.146，95% CI：1.352-7.320，P< 0.01）和混合组织学类型（OR：3.635，95% CI：1.272-10.390，P < 0.05）是早期胃癌患者 LNM 的独立危险因素。然而，混合组织学类型不影响这些患者的生存结果（风险比：0.629，95% CI：0.074-5.311，P > 0.05）。

结论

混合组织学类型是早期胃癌患者淋巴结转移的独立危险因素。应仔细考虑有关混合组织学类型的内镜粘膜下剥离术的决定。