255例早期胃癌临床病理及蓝激光成像结合放大内镜下的特征分析

Features of clinicopathology and blue laser imaging combined with magnification endoscopy of patients with early gastric cancer

摘要:

目的 探讨早期胃癌的临床生物学特点及蓝激光成像结合放大内镜（BLI-ME）的诊断价值。 方法 2014年1月到2017年1月，复旦大学附属华山医院手术病理确诊的255例早期胃癌病例纳入回顾性研究，包括33例手术前行BLI-ME精查者。依据日本胃癌学会2010年指南将胃癌病理组织学分为分化型和未分化型早期胃癌，比较分析其临床特点、内镜下特征、病理分型、淋巴结转移情况及BLI-ME下的病变特点。 结果 255例早期胃癌中，男164例（63.31％），＞40岁者242例（94.90％），分化型182例（71.37％），病变位于胃窦93例（36.47％），内镜下0-Ⅱc型92例（36.08％）；发生淋巴结转移37例（14.51％），对比分析发现，淋巴结转移率黏膜内癌明显低于黏膜下癌［5.04％（7／139）比25.86％（30／116），χ2=22.109，P=0.000］，分化型癌明显低于未分化型癌［9.89％（18／182）比26.03％（19／73），χ2=10.938，P=0.002］，病灶最大径≤2.0 cm明显低于＞2.0 cm［9.88％（16／162）比22.58％（21／93），χ2=7.687，P=0.009］。33例行BLI-ME精查者中，分化型早期胃癌以FNP（13.64％，3／22）、ILL-1（59.09％，13／22）、ILL-2（22.73％，5／22）为主，未分化型早期胃癌可见ILL-2（45.45％，5／11）、CSP（54.55％，6／11）。 结论 早期胃癌发病率男性多于女性，大多数患者年龄在40岁以上，好发于胃窦部，内镜下形态以0-Ⅱc型居多。癌灶＞2.0 cm或侵及黏膜下层，以及未分化型癌易发生淋巴结转移。临床行BLI-ME精查，对黏膜异常微血管形态及异常微腺管结构进行观察，有助于判断早期胃癌的病理分型。

Abstract:

Objective To study the clinical and pathological characteristics of early gastric cancer （EGC） and to evaluate the value of blue laser imaging combined with magnification endoscopy （BLI-ME） in the diagnosis of EGC. Methods A retrospective study was conducted on data of 255 patients with EGC diagnosed in Huashan Hospital from January 2014 to January 2017， including 33 cases of preoperative BLI-ME intensive examination. According to the Japanese classification of gastric carcinoma of Japanese Gastric Cancer Association， the EGCs were histopathologically divided into differentiated and undifferentiated subtypes. Clinical characteristics， endoscopic features， pathological type， lymph node metastasis， and lesion characteristics of BLI-ME were analyzed. Results Among the 255 cases of EGC， 164 cases （63.31％） were male， 242 cases （94.90％） were over 40 years old， 182 cases （71.37％） belonged to differentiated type， 93 cases （36.47％） were located in gastric antrum， 92 cases （36.08％） were type 0-Ⅱc under endoscopy， and 37 cases （14.51％） had lymph node metastasis. Comparative analysis showed that the lymph node metastasis rate was significantly lower in mucosal carcinoma compared to submucosal carcinoma［5.04％ （7／139） VS 25.86％ （30／116）， χ2=22.109， P=0.000］， lower in differentiated carcinoma compared to undifferentiated carcinoma［9.89％ （18／182） VS 26.03％ （19／73）， χ2=10.938， P=0.002］， and lower in tumors with maximum diameter of lesion≤2.0 cm compared to maximum diameter of lesion＞2.0 cm［9.88％ （16／162） VS 22.58％ （21／93）， χ2=7.687， P=0.009］. Among the 33 cases undergoing BLI-ME， differentiated EGC was mainly fine-network pattern （13.64％， 3／22）， intralobular loop pattern （ILL）-1 （59.09％， 13／22） and ILL-2 （22.73％， 5／22）， whereas undifferentiated subtype patients were characterized as ILL-2 （45.45％， 5／11） and corkscrew pattern （54.55％， 6／11）. Conclusion The incidence of EGC is higher in male with age over 40 years. Gastric lesions occur most frequently in the antrum， and the most common microscopic morphology is 0-Ⅱc type. Tumor＞2.0 cm or invasion of submucous layer， and undifferentiated carcinoma are prone to lymph node metastasis. The assessment of mucosal microvascular pattern and micro surface structure under BLI-ME facilitate to determine the pathological type of EGC.