The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma

Background: Gastric adenocarcinoma is more often found in men over 50 years in the form of an antral lesion. The tumor has heterogeneous histopathologic features and a poor prognosis (median survival of 15% in five years). Aim: To estimate the relationship between the presence of nodal metastasis and other prognostic factors in sporadic gastric adenocarcinoma. Method: Were evaluated 164 consecutive cases of gastric adenocarcinoma previously undergone gastrectomy (partial or total), without clinical evidence of distant metastasis, and determined the following variables: topography of the lesion, tumor size, Borrmann macroscopic configuration, histological grade, early or advanced lesions, Lauren histological subtype, presence of signet ring cell, degree of invasion, perigastric lymph node status, angiolymphatic/perineural invasion, and staging. Results: Were found 21 early lesions (12.8%) and 143 advanced lesions (87.2%), with a predominance of lesions classified as T3 (n=99/60, 4%) and N1 (n=62/37, 8%). The nodal status was associated with depth of invasion (p<0.001) and tumor size (p<0.001). The staging was related to age (p=0.048), histological grade (p=0.003), and presence of signet ring cells (p = 0.007), angiolymphatic invasion (p = 0.001), and perineural invasion (p=0.003). Conclusion: In gastric cancer, lymph node involvement, tumor size and depth of invasion are histopathological data associated with the pattern of growth/tumor spread, suggesting that a wide dissection of perigastric lymph nodes is a fundamental step in the surgical treatment of these patients.

背景：胃腺癌（Gastric adenocarcinoma）好发于50岁以上男性，多表现为窦部病变。该肿瘤组织病理学特征异质性强，预后较差，5年中位生存率仅15%。
目的：探讨散发性胃腺癌（sporadic gastric adenocarcinoma）中淋巴结转移状态与其他预后因素的相关性。
方法：本研究纳入164例既往接受胃切除术（部分或全胃切除）的连续性散发性胃腺癌病例，所有病例均无远处转移的临床证据，并对以下变量进行评估：病变部位、肿瘤大小、Borrmann宏观分型、组织学分级、病变分期（早期/进展期）、Lauren组织学分型、印戒细胞（signet ring cell）是否存在、浸润深度、胃周淋巴结状态、血管/淋巴管/神经侵犯情况，以及病理分期。
结果：本研究中共检出21例早期病变（12.8%）、143例进展期病变（87.2%），其中以T3分期（n=99，占比60.4%）和N1分期（n=62，占比37.8%）病例居多。淋巴结状态与浸润深度（p<0.001）及肿瘤大小（p<0.001）显著相关；病理分期与患者年龄（p=0.048）、组织学分级（p=0.003）、印戒细胞存在与否（p=0.007）、血管/淋巴管侵犯（p=0.001）及神经侵犯（p=0.003）均存在相关性。
结论：在胃腺癌中，淋巴结受累情况、肿瘤大小及浸润深度均为与肿瘤生长/扩散模式相关的组织病理学指标，提示胃周淋巴结广泛清扫是此类患者外科治疗中的关键步骤。