Clinicopathologic features of early gastric carcinoma with lymphoid stroma and feasibility of endoscopic submucosal dissection
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Gastric carcinoma with lymphoid stroma (GCLS) is a rare disease known to have unique features and a favorable prognosis. This study aimed to determine the clinicopathologic features of early GCLS (EGCLS) and define the feasibility of endoscopic submucosal dissection (ESD) for EGCLS.
We performed a retrospective analysis of 70 EGCLS patients treated via ESD or surgery and 1626 patients who underwent surgical resection for early non-GCLS (ENGCLS) between January 2007 and December 2014 at Pusan National University Hospital, Busan, Republic of Korea.
The mean age of EGCLS patients was 58 years (range 36–77 years); a male predominance (3.7:1) was observed, and 81.4% showed Epstein–Barr virus positivity. Compared with ENGCLS, EGCLS was macroscopically more elevated (34.3 vs. 18.0%, P = 0.003) and located more proximally (upper third: 37.1 vs. 9.7%, P < 0.001). Tumor size was smaller (2.1 ± 1.1 vs. 3.1 ± 2.0 cm, P < 0.001), but submucosal invasion was more frequent (77.1 vs. 44.4%, P < 0.001) and deeper in the EGCLS group. Among the 59 EGCLS patients who were treated surgically, only two (3.4%) showed lymph node metastasis (LNM). Despite submucosal invasion, EGCLS showed a lower LNM rate (4.0 vs. 19.4%, P = 0.007) than ENGCLS, even in patients with SM3 EGCLS (5.3 vs. 24.5%, P = 0.007). There were no recurrences in the available ten patients who underwent ESD alone during a mean follow-up of 37.2 months.
In this study, we observed unique clinicopathologic features with a very low LNM rate in EGCLS. We consider ESD a potentially curative treatment strategy for EGCLS despite deep submucosal invasion, especially in patients with poor performance status and significant comorbidities.
KeywordsGastric carcinoma with lymphoid stroma Early gastric cancer Endoscopic submucosal dissection
Crohn’s disease-like lymphocytic reaction
Differentiated type-predominant ENGCLS
Epstein–Barr virus-associated gastric carcinoma
Early gastric carcinoma with lymphoid stroma
Endoscopic submucosal dissection
Gastric carcinoma with lymphoid stroma
In situ hybridization
Lymph node metastasis
Non-EGCLS (early gastric carcinoma with lymphoid stroma)
Undifferentiated-type predominant ENGCLS
This study was supported by a grant from the National R&D Program for Cancer Control, Ministry for Health, Welfare and Family affairs, Republic of Korea (0920050) and a grant for the Korea Healthcare technology R&D project, Ministry for Health & Welfare, Republic of Korea (A121994). The supporting organization had no role in the study design, collection, analysis, and interpretation of the data or writing of the report.
Compliance with ethical standards
Authors Dong Hun Shin, Gwang Ha Kim, Bong Eun Lee, Jong Wook Lee, Dong Woo Ha, Hye Kyung Jeon, Dong Hoon Baek, Geun Am Song, Sang Jeong Ahn, and Do Youn Park have no conflicts of interest or financial ties to disclose.
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