| Objective: Gastric cancer is divided into two main histological types:differentiated cancer and undifferentiated cancer.Differentiated carcinoma includes: papillary adenocarcinoma,well differentiated tubular adenocarcinoma and moderately differentiated tubular adenocarcinoma;undifferentiated carcinoma includes: poorly differentiated adenocarcinoma,signet ring cell carcinoma and mucinous adenocarcinoma;gastric carcinoma with both differentiated and undifferentiated components is called mixed histological type gastric carcinoma.The main purpose of this study is to study the clinicopathological characteristics and lymph node metastasis of mixed histologic gastric cancer in northern GuilinMethods: a total of 989 patients with gastric cancer who underwent radical gastrectomy and D2 lymph node dissection in the Guilin Medical College Hospital from December 2004 to December 2020 were retrospectively analyzed,including 339 cases of early gastric cancer and 650 cases of advanced gastric cancer.They were divided into mixed type group,differentiated type group and undifferentiated type group,respectively.Logistic regression analysis was used to analyze the risk factors of lymph node metastasis of early gastric cancer.The risk of lymph node metastasis of early gastric cancer was assessed by multi index combined diagnostic test.Results: The average age of patients with mixed type of early gastric cancer was 57.35 ± 11.24 years(P = 0.020);the clinical manifestations of patients with different histological types of early gastric cancer were different(P= 0.016);the depth of invasion was deeper(P = 0.005);the tumor diameter was larger(P = 0.001)= The average diameter was 2.5(1.5-3.2)cm;compared with differentiated type,the time from clinical symptoms to onset was shorter(P =0.000);the risk of lymph node metastasis was higher(P = 0.008)and the number of regional lymph node metastasis was more(P = 0.048);the expression of Ki-67 was lower than 50%(P = 0.009).Compared with undifferentiated type,mixed type of early gastric cancer was less complicated with ulcer(P = 0.009),and the proportion of microsatellite stability was higher(P = 0.036).The patients with mixed advanced gastric cancer were younger(P = 0.000),smaller in diameter(P = 0.005),deeper in invasion(P = 0.000),higher in borrman type IV(P = 0.008),and higher in HER 2+ and 3+ expression(P = 0.006).Compared with undifferentiated type,the proportion of microsatellite instability molecular types in mixed type advanced gastric cancer was higher(P = 0.034).In univariate analysis,tumor diameter > 2cm(P = 0.000),presence of ulcer(P =0.010),vascular invasion(P = 0.012)and histological type(P = 0.004)were associated with lymph node metastasis of early gastric cancer.According to multivariate logistic analysis,mixed histological type(P = 0.019)and undifferentiated histological type [β =-0.230,or 0.794,95% CI 0.255 – 2.475,(P = 0.691)] were independent risk factors for lymph node metastasis in patients with early gastric cancer.The area under the ROC curve was 0.745 [95% CI0.676-0.814,(P = 0.000)],the cut-off value of the curve was 0.092,the corresponding sensitivity was 92.9%,and the specificity was 54.2%.Conclusions: 1.Mixed type of early gastric cancer has strong invasion ability,and mixed tissue type is an independent risk factor for lymph node metastasis in patients with early gastric cancer.2.The mixed histological type may be the indication of targeted therapy and immunotherapy.3.The model of lymph node metastasis risk prediction based on the combination of histology type and multi index diagnostic test has high sensitivity and specificity,which can provide some reference for the treatment of early gastric cancer. |
PDF Full Text Request