Abstract
Background
We recently reported that the presence of a papillary adenocarcinoma (pap) component was an independent risk factor for lymphatic involvement in endoscopically resected early gastric cancer (EGC). This study aimed to investigate the potential association between the presence of a pap component in EGC and lymph node metastasis (LNM).
Methods
In order to evaluate the association between LNM and clinicopathological features, including a pap component, we reviewed 628 surgically resected EGCs at our institution between 2009 and 2012. Clinicopathological features included age, gender, tumor location, macroscopic type, tumor size, histological type, depth, ulcerative findings, and lymphatic and venous involvement. In addition, the association between clinicopathological features and lymphatic involvement was also evaluated.
Results
LNM was observed in 52 cases (8.3%). Univariate analyses revealed a significant correlation between a pap component and LNM as well as tumor size, depth, macroscopic type, a poorly differentiated adenocarcinoma component, and lymphatic and venous involvement. The percentage of positive LNM among the EGC cases with a pap component was significantly higher than in those without the component (18.2 vs. 7.3%, P = 0.010). Via multivariate analyses lymphatic involvement was identified as the strongest risk factor for LNM [odds ratio (OR) 14.1] and a pap component was revealed as an independent risk factor for lymphatic involvement (OR 3.1).
Conclusion
Our study revealed that EGC cases with a pap component were at higher risk of lymphatic involvement and showed a higher percentage of positive LNM. More attention should be paid to a pap component in EGC.
Similar content being viewed by others
References
Rembacken BJ, Gotoda T, Fujii T, et al. Endoscopic mucosal resection. Endoscopy. 2001;33:709–18.
Soetikno RM, Gotoda T, Nakanishi Y, et al. Endoscopic mucosal resection. Gastrointest Endosc. 2003;57:567–79.
Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–9.
Oda I, Gotoda T, Hamanaka H, et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc. 2005;17:54–8.
Oda I, Saito D, Tada M, et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer. 2006;9:262–70.
Yamao T, Shirao K, Ono H, et al. Risk factors for lymph node metastasis from intramucosal gastric carcinoma. Cancer. 1996;77:602–6.
Kurihara N, Kubota T, Otani Y, et al. Lymph node metastasis of early gastric cancer with submucosal invasion. Br J Surg. 1998;85:835–9.
Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.
Gotoda T, Sasako M, Ono H, et al. Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg. 2001;88:444–9.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd english edition. Gastric Cancer. 2011;14:101–12.
Association Japanese Gastric Cancer. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.
Lauwers GY, Carneiro F, Graham DY, et al. Gastric carcinoma. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. WHO classification of tumors of the digestive system. 4th ed. Lyon: IARC; 2010. p. 48–58.
Nishida T, Tanaka S, Haruma K, et al. Histologic grade and cellular proliferation at the deepest invasive portion correlate with the high malignancy of submucosal invasive gastric carcinoma. Oncology. 1995;52:340–6.
Yasuda K, Adachi Y, Shiraishi N, et al. Papillary adenocarcinoma of the stomach. Gastric Cancer. 2000;3:33–8.
Koseki K, Takizawa T, Koike M, et al. Distinction of differentiated type early gastric carcinoma with gastric type mucin expression. Cancer. 2000;89:724–32.
Sekiguchi M, Sekine S, Oda I, et al. Risk factors for lymphatic and venous involvement in endoscopically resected gastric cancer. J Gastroenterol. 2013;48:706–12.
Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376:687–97.
Rüschoff J, Hanna W, Bilous M, et al. HER2 testing in gastric cancer: a practical approach. Mod Pathol. 2012;25:637–50.
Kaizaki Y, Hosokawa O, Miyanaga T, et al. Pathological characteristics of early gastric cancer with mixed histological types. Stomach and Intestine. 2013;48:1539–51 (in Japanese).
Wolff AC, Hammond ME, Hicks DG, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.
Noguchi Y. Blood vessel invasion in gastric carcinoma. Surgery. 1990;107:140–8.
Arigami T, Natsugoe S, Uenosono Y, et al. Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer. Br J Cancer. 2005;93:688–93.
Sako A, Kitayama J, Ishikawa M, et al. Impact of immunohistochemically identified lymphatic invasion on nodal metastasis in early gastric cancer. Gastric Cancer. 2006;9:295–302.
Yonemura Y, Endou Y, Tabachi K, et al. Evaluation of lymphatic invasion in primary gastric cancer by a new monoclonal antibody, D2-40. Hum Pathol. 2006;37:1193–9.
Kahn HJ, Marks A. A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumors. Lab Invest. 2002;82:1255–7.
Luinetti O, Fiocca R, Villani L, et al. Genetic pattern, histological structure, and cellular phenotype in early and advanced gastric cancers: evidence for structure-related genetic subsets and for loss of glandular structure during progression of some tumors. Hum Pathol. 1998;29:702–9.
Arai T, Esaki Y, Inoshita N, et al. Pathologic characteristics of gastric cancer in the elderly: a retrospective study of 994 surgical patients. Gastric Cancer. 2004;7:154–9.
Ha TK, An JY, Youn HK, et al. Indication for endoscopic mucosal resection in early signet ring cell gastric cancer. Ann Surg Oncol. 2008;15:508–13.
Kim HM, Pak KH, Chung MJ, et al. Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions. Surg Endosc. 2011;25:3087–93.
Shiroshita H, Watanabe H, Ajioka Y, et al. Re-evaluation of mucin phenotypes of gastric minute well-differentiated-type adenocarcinomas using a series of HGM, MUC5AC, MUC6, M-GGMC, MUC2 and CD10 stains. Pathol Int. 2004;54:311–21.
Shibata N, Watari J, Fujiya M, et al. Cell kinetics and genetic instabilities in differentiated type early gastric cancers with different mucin phenotype. Hum Pathol. 2003;34:32–40.
Nakamoto J, Torisu R, Aoki R, et al. Clinicopathological evaluation of biological behavior of submucosal invasive gastric carcinomas: relationship among lymph node metastasis, mucin phenotype and proliferative activity. J Med Invest. 2007;54:99–108.
Guo RJ, Arai H, Kitayama Y, et al. Microsatellite instability of papillary subtype of human gastric adenocarcinoma and hMLH1 promoter hypermethylation in the surrounding mucosa. Pathol Int. 2001;51:240–7.
Song JP, Kitayama Y, Igarashi H, et al. Centromere numerical abnormality in the papillary, papillotubular type of early gastric cancer, a further characterization of a subset of gastric cancer. Int J Oncol. 2002;21:1205–11.
Arai T, Sakurai U, Sawabe M, et al. Frequent microsatellite instability in papillary and solid-type, poorly differentiated adenocarcinomas of the stomach. Gastric Cancer. 2013;16:505–12.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sekiguchi, M., Kushima, R., Oda, I. et al. Clinical significance of a papillary adenocarcinoma component in early gastric cancer: a single-center retrospective analysis of 628 surgically resected early gastric cancers. J Gastroenterol 50, 424–434 (2015). https://doi.org/10.1007/s00535-014-0991-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-014-0991-6