Background/Objectives: The curability of endoscopic submucosal dissection (ESD) for early gastric lymphoepithelioma-like carcinoma (LELC) remains unclear, as this rare histological subtype is not well represented in current guidelines. We aimed to evaluate the clinicopathological features and outcomes of early gastric LELC following ESD. Methods: We retrospectively compared 51 patients with early gastric LELC and 8243 patients with well- or moderately differentiated (WD or MD) tubular adenocarcinoma who underwent ESD. Results: LELC was more frequently located in the proximal stomach than WD/MD adenocarcinoma (52.9% vs. 10.3%). The deep submucosal invasion rate was significantly higher in LELC (77.3% vs. 9.5%), whereas the lymphatic invasion rate was comparable between the two groups (5.7% vs. 9.2%). No LELC cases were diagnosed preoperatively using forceps biopsy. Despite the comparable en bloc with R0 and complete resection rates, the curative resection rate of LELC was significantly lower than that of WD/MD adenocarcinoma, primarily due to deep submucosal invasion. Post-ESD bleeding was more frequent in LELC (11.3% vs. 2.7%). During a mean follow-up of 38.1 months, no extra-gastric recurrence was observed in patients who did not undergo additional surgery, and no lymph node metastasis was detected among the 23 patients who underwent gastrectomy. No gastric cancer-specific deaths occurred in the study population during follow-up. Conclusions: Considering these favorable long-term outcomes despite a low curative resection rate, early gastric LELC fulfilling the conventional curative criteria of current guidelines can be regarded as having been curatively treated by ESD, particularly in patients with high surgical morbidity.
背景/目的：内镜黏膜下剥离术（ESD）治疗早期胃淋巴上皮瘤样癌（LELC）的根治性尚不明确，因为这种罕见的组织学亚型在当前指南中代表性不足。本研究旨在评估ESD术后早期胃LELC的临床病理特征及预后。方法：我们回顾性比较了51例接受ESD治疗的早期胃LELC患者与8243例高/中分化管状腺癌（WD/MD）患者。结果：LELC较WD/MD腺癌更常发生于胃近端（52.9% vs. 10.3%）。LELC的黏膜下深层浸润率显著更高（77.3% vs. 9.5%），而两组间淋巴管浸润率相当（5.7% vs. 9.2%）。所有LELC病例术前均未通过钳夹活检确诊。尽管整块切除率、R0切除率和完全切除率相近，但LELC的根治性切除率显著低于WD/MD腺癌，主要归因于黏膜下深层浸润。LELC组ESD术后出血发生率更高（11.3% vs. 2.7%）。在平均38.1个月的随访期内，未接受追加手术的患者未出现胃外复发，23例接受胃切除术的患者均未发现淋巴结转移。随访期间研究人群未出现胃癌特异性死亡。结论：尽管根治性切除率较低，但考虑到其良好的长期预后，符合现行指南传统根治标准的早期胃LELC可被视为通过ESD获得根治性治疗，尤其适用于手术并发症风险较高的患者。
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