伴有淋巴样间质的早期胃癌临床病理特征

Clinicopathological features of early gastric carcinoma with lymphoid stroma

    摘要
  • 摘要:
    目的 探讨伴有淋巴样间质的早期胃癌（early gastric carcinoma with lymphoid stroma，EGCLS）的临床病理特征。
    方法 回顾性分析2007年1月至2023年12月于常州市第二人民医院接受根治性胃切除术的连续27例EGCLS，随机选取69例相同T分期的早期胃癌作为对照组。采用免疫组织化学检测P53、错配修复蛋白、PD-L1、E-cad、HER2的表达。对HER2 2+病例行FISH检测，原位杂交法检测EB病毒。
    结果 两组在性别、年龄、肿瘤部位和直径、溃疡、脉管侵犯、神经侵犯、肿瘤出芽级别、P53和错配修复蛋白表达方面无显著性差异（均P>0.05）。EGCLS侵犯SM2（88.9%）、低分化（70.4%）、推挤式浸润（48.1%）、PD-L1阳性（59.3%）、EBER阳性（55.6%）、E-cad异常表达（48.1%）的比例显著高于对照组（59.4%、46.4%、18.8%、24.6%、1.4%、23.2%，均P<0.05），而淋巴结转移率（7.4%）、隆起型比例（14.8%）均显著低于对照组（30.4%、40.6%，均P<0.05）。脉管侵犯、肿瘤出芽、非EGCLS是淋巴结转移的危险因素，其中脉管侵犯是独立危险因素。
    结论 EGCLS是早期胃癌的少见亚型，具有较低的淋巴结转移率和较高的EBER阳性或错配修复蛋白缺陷率，不适合外科手术的患者可考虑内镜下切除或免疫治疗。

     

    Abstract:
    Objective  To investigate the clinicopathological characteristics of patients with early gastric carcinoma with lymphoid stroma (EGCLS).
    Methods A retrospective analysis was conducted on 27 consecutive patients with EGCLS who underwent radical surgery at The Second People’s Hospital of Changzhou between January 2007 and December 2023. Sixty-nine cases of conventional early gastric carcinoma with matched T stages were randomly selected as controls. Immunohistochemical staining was performed to detect the expression of P53, mismatch repair (MMR) proteins, programmed death-ligand 1 (PD-L1), E-cadherin, and human epidermal growth factor receptor 2 (HER2) in the study cohort. FISH analysis was conducted on HER2 2+ cases, and in situ hybridization was used to detect Epstein-Barr virus (EBV).
    Results No significant differences were observed between the two groups in terms of patient sex, age, tumor location, size, ulceration, lymphovascular or perineural invasion, tumor budding grade, P53 expression, or MMR protein deficiency. The EGCLS group showed significantly higher proportions of SM2 invasion (88.9%), poor tumor differentiation (70.4%), pushing tumor border (48.1%), PD-L1 positivity (59.3%), Epstein–Barr virus-encoded small RNA (EBER) positivity (55.6%), and abnormal E-cadherin expression (48.1%) compared to the control group (59.4%, 46.4%, 18.8%, 24.6%, 1.4%, and 23.2%, respectively; P<0.05). The frequency of lymph node metastasis (7.4%) and the proportion of elevated macroscopic type (14.8%) in the EGCLS group were significantly lower than in the control group (30.4% and 40.6%, respectively; P<0.05). Lymphovascular invasion, tumor budding grade, and non-EGCLS status were identified as risk factors for lymph node metastasis, with lymphovascular invasion being the only independent risk factor.
    Conclusions EGCLS is a rare subtype of early gastric carcinoma characterized by a low frequency of lymph node metastasis and a high proportion of EBER positivity or MMR protein deficiency. Endoscopic resection or immunotherapy may be preferred treatment options for patients who are not suitable candidates for surgery.

     

    • HTML全文
    • 参考文献(17)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回