Skip to main content

Advertisement

SpringerLink
Log in

Histological mixed-type as an independent risk factor for nodal metastasis in submucosal gastric cancer

  • Original Article
  • Published:
Tumor Biology

Abstract

Recent studies reported that the histological mixed-type, which consists of differentiated and undifferentiated components, was related to the aggressive clinical features of gastric cancer as well as its poor outcomes. This study was designed to investigate the influences of the mixed-type on lymph node metastasis in patients with submucosal gastric cancer. We analyzed a total of 239 consecutive patients who underwent curative gastrectomy for submucosal gastric cancer between 2004 and 2012 from their hospital records. The overall prevalence of histological mixed-type in submucosal gastric cancer was 46.9 % (112/239). The histological mixed-type correlated more strongly with lymph node metastasis (P = 0.0016; 25.0 % (28/112)) than the undifferentiated type in the Japanese classification of gastric carcinoma (JCGC) (P = 0.2779; 20.5 % (17/83)) and 7th tumor-node-metastasis (TNM) (P = 0.0476; 20.7 % (31/150)) classifications. Univariate and multivariate logistic regression analyses identified a tumor size of 25 mm or greater (P = 0.0003, OR 4.51 (95 % CI 1.95–11.9)) and the histological mixed-type (P = 0.0316, OR 4.02 (95 % CI 1.12–19.2)) as independent risk factors for lymph node metastasis. The incidence of lymph node metastasis was high in patients with both these factors (33.8 % (23/68)) and low in patients without both factors (3.0 % (2/67)). These results suggest that the histological mixed-type correlated more strongly with lymph node metastasis than the undifferentiated type in the JCGC and TNM classifications and highlight its usefulness as a risk factor for lymph node metastasis in submucosal gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5(1):1–5. doi:10.1007/s101200200000.

    Article  PubMed  Google Scholar 

  2. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23. doi:10.1007/s10120-011-0042-4.

  3. Popiela T, Kulig J, Kolodziejczyk P, Sierzega M. Long-term results of surgery for early gastric cancer. Br J Surg. 2002;89(8):1035–42. doi:10.1046/j.1365-2168.2002.02156.x.

    Article  CAS  PubMed  Google Scholar 

  4. Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T. Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg. 2001;88(3):444–9. doi:10.1046/j.1365-2168.2001.01725.x.

    Article  CAS  PubMed  Google Scholar 

  5. Folli S, Morgagni P, Roviello F, De Manzoni G, Marrelli D, Saragoni L, et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol. 2001;31(10):495–9.

    Article  CAS  PubMed  Google Scholar 

  6. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12. doi:10.1007/s10120-011-0041-5.

  7. Sobin LGM, Wittekind C, editors. International union against cancer. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2010.

    Google Scholar 

  8. Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gan. 1968;59(3):251–8.

    CAS  PubMed  Google Scholar 

  9. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31–49.

    CAS  PubMed  Google Scholar 

  10. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, 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(4):219–25.

    Article  PubMed  Google Scholar 

  11. Hanaoka N, Tanabe S, Mikami T, Okayasu I, Saigenji K. Mixed-histologic-type submucosal invasive gastric cancer as a risk factor for lymph node metastasis: feasibility of endoscopic submucosal dissection. Endoscopy. 2009;41(5):427–32. doi:10.1055/s-0029-1214495.

    Article  CAS  PubMed  Google Scholar 

  12. Ito H, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, et al. Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study. J Exp Clin Cancer Res. 2011;30:117. doi:10.1186/1756-9966-30-117.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Takizawa K, Ono H, Kakushima N, Tanaka M, Hasuike N, Matsubayashi H, et al. Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection. Gastric Cancer. 2013;16(4):531–6. doi:10.1007/s10120-012-0220-z.

    Article  CAS  PubMed  Google Scholar 

  14. Tanabe H, Iwashita A, Haraoka S. Clinicopathological characteristics of differentiated mixed-type early gastric carcinoma with lymph node metastasis [in Japanese with English abstract]. Stom Int. 2007;42:1561–76.

  15. Watanabe GAY, Kato T. Pathological characteristics of differentiated-type early gastric carcinoma mixed with undifferentiated-type-Status of lymph node metastasis and macroscopic features [in Japanese with English abstract]. Stom Int. 2007;42:1577–87.

    Google Scholar 

  16. Zheng HC, Li XH, Hara T, Masuda S, Yang XH, Guan YF, et al. Mixed-type gastric carcinomas exhibit more aggressive features and indicate the histogenesis of carcinomas. Virchows Arch. 2008;452(5):525–34. doi:10.1007/s00428-007-0572-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shimizu H, Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, et al. The decision criterion of histological mixed type in “T1/T2” gastric carcinoma—comparison between TNM classification and Japanese Classification of Gastric Cancer. J Surg Oncol. 2012;105(8):800–4. doi:10.1002/jso.23010.

    Article  PubMed  Google Scholar 

  18. Huh CW, da Jung H, Kim JH, Lee YC, Kim H, Kim H, et al. Signet ring cell mixed histology may show more aggressive behavior than other histologies in early gastric cancer. J Surg Oncol. 2013;107(2):124–9. doi:10.1002/jso.23261.

    Article  PubMed  Google Scholar 

  19. Zhu Z, Sun X, Wang J, Sun Z, Wang Z, Zheng X, et al. Histopathology-based prognostic score is independent prognostic factor of gastric carcinoma. BMC Cancer. 2014;14:663. doi:10.1186/1471-2407-14-663.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Komatsu S, Ichikawa D, Miyamae M, Shimizu H, Konishi H, Shiozaki A, et al. Histological mixed-type as an independent prognostic factor in stage I gastric carcinoma. World J Gastroenterol. 2015;21(2):549–55. doi:10.3748/wjg.v21.i2.549.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Park SY, Kook MC, Kim YW, Cho NY, Kim TY, Kang GH. Mixed-type gastric cancer and its association with high-frequency CpG island hypermethylation. Virchows Arch. 2010;456(6):625–33. doi:10.1007/s00428-010-0916-6.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Author notes

    Authors and Affiliations

    1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

      Mahito Miyamae, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara & Eigo Otsuji

    2. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

      Mitsuo Kishimoto

    Authors
    1. Mahito Miyamae
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Shuhei Komatsu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Daisuke Ichikawa
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Toshiyuki Kosuga
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Takeshi Kubota
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Kazuma Okamoto
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Hirotaka Konishi
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Atsushi Shiozaki
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Hitoshi Fujiwara
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Mitsuo Kishimoto
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Eigo Otsuji
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Shuhei Komatsu.

    Additional information

    Mahito Miyamae and Shuhei Komatsu contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Miyamae, M., Komatsu, S., Ichikawa, D. et al. Histological mixed-type as an independent risk factor for nodal metastasis in submucosal gastric cancer. Tumor Biol. 37, 709–714 (2016). https://doi.org/10.1007/s13277-015-3864-6

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s13277-015-3864-6

    Keywords

    Search

    Navigation