中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (08): 666-669.

• 专题笔谈 • 上一篇    下一篇

胃癌转移规律研究新进展

徐惠绵，徐    岩   

  1. 中国医科大学附属第一医院胃肠肿瘤外科，辽宁沈阳 110001
  • 出版日期:2011-08-01 发布日期:2011-08-01

  • Online:2011-08-01 Published:2011-08-01

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摘要：

胃癌转移方式按好发程度依次为淋巴结转移、腹膜种植转移和血行转移。淋巴结转移的高危因素包括浸润深度，大体类型，生长方式，癌灶长径>4cm，低分化，淋巴管受侵阳性等。有无淋巴结转移是影响早期胃癌预后最重要的独立危险因素。术中腹腔冲洗液脱落癌细胞（ECC）检查是诊断或检测潜在腹膜转移的常用方法和金标准。不同的浆膜分型是预测胃癌根治术后腹膜复发的独立危险因素。CEA、肝素酶等肿瘤标记物对检测或预测腹膜转移具有较好的临床意义。胃癌的血行转移多发生于肝、肺、骨等脏器。隆起型、高分化、AFP阳性的肝样腺癌、团块状生长、静脉癌栓阳性病例易发生肝转移。浸润型、低分化、静脉癌栓阳性是胃癌肺、骨转移的病理生物学特征。

关键词: 胃癌, 淋巴结转移, 前哨淋巴结, 腹膜转移, 血行转移

Abstract:

Recent advancement in metastasis of gastric cancer                 XU Hui-mian, XU Yan. Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Corresponding author: XU Hui-mian, E-mail:xuhuimian@126.com
Abstract    Metastases of gastric cancer includes lymph node, peritoneal and blood metastasis serially according to the incidence. Depth of tumors invasion, macroscopic type, tumors >4cm in diameter, poor-differentiated and the presence of lymphatic invasion are important determinants of the lymph node metastasis. Lymph node metastasis is the most important prognostic factor for early gastric cancer. The cytological detection of exfoliated cancer cells (ECCs) is the criterion for identifying risk of peritoneal metastasis. Macroscopic serosal classification can be used to be a predictor of peritoneal recurrence. Carcinoembryonic antigen (CEA) and heparanase have been considered the valuable indicator to predict peritoneal metastasis. Gastric cancer with elevated type, well-differentiated, hepatoid adenocarcinoma and the presence of venous invasion are associated with liver metastasis. The characteristics of gastric cancer with lung or bone metastasis include the infiltrating carcinoma, poor-differentiated and the presence of venous invasion.

Key words: gastric cancer, lymph node metastasis, sentinel lymph node, peritoneal metastasis, blood metastasis