胃粘膜内癌のリンパ節転移と予後

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  • RISK FACTORS OF LYMPH NODE METASTASES AND RECURRENCE FROM INTRAMUCOSAL GASTRIC CANCER

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Four hundred and sixty-four patients with solitary intramucosal gastric cancer were subjected to a study of risk factors of lymph node metastases and the recurrence. Lymph node metastases were recognized in 6 cases (1.3%, n1 2, n2 4). The largest diameters of these tumors ranged from 1 cm to 10 cm (mean 5.6 cm). They showed macroscopically depressed types including 3 IIc types, IIc+III type, 3 type and 5 type. Histology revealed all the tumors contained foci of poorly differentiated adenocarcinoma including 3 por, 2 sig and tub 2. Intramucosal gastric cancers with lymph node metastases were characterized by larger diameter, more often associated ulceration and more often overstimated serosal invasion than those without lymph node metastases. Three of 6 patiens with lymph node metastases died of cancer recurrence at 25, 61 and 71 months after surgery. The 4 recurrent cases died of cancer and had larger diameter (more than 4 cm) and were more often associated with ulceration and lymph node metastases than nonrecurrent 399 cases. We conclude that the depressed poorly differentiated gastric cancer with ulceration, even if it is an intramucosal cancer, can metastasize to lymph nodes; such a cancer should be treated by gastrectomy with lymph node dissection; and postoperative adjuvant chemotherapy should be mandatory, if lymph node metastases exist.

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