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Clinical implication of endoscopic gross appearance in early gastric cancer: revisited

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Abstract

Background

The macroscopic appearance of early gastric cancer (EGC) is known to reflect its growth patterns. The purpose of this study was to investigate the role of the endoscopic appearance as a predictor of clinical behavior in EGC.

Methods

Between January 2005 and December 2008, 1,845 patients were diagnosed with EGC and underwent surgery. The clinicopathologic characteristics were retrospectively analyzed according to gross appearance. Endoscopic findings were classified by predominant type as elevated, flat, or depressed. Flat and depressed types were categorized together as nonelevated type.

Results

The proportions of elevated, flat, and depressed types were 16.6, 28.6, and 54.8 %. The gross appearance of the elevated type predominantly showed well/moderate differentiation, whereas the flat and depressed types showed signet-ring cells and poor differentiation, respectively. When the elevated and nonelevated types were compared, submucosal invasion, lymphovascular invasion (LVI), and lymph-node metastasis (LNM) were higher in elevated than in nonelevated type. In differentiated EGC, submucosal invasion, LVI, LNM, and multiplicity were significantly higher in the elevated than the nonelevated type. These patterns were significantly common in the order elevated, depressed, and flat types. In undifferentiated EGC, submucosal invasion, LVI, and perineural invasion were significantly higher in elevated than in nonelevated type. These patterns were significantly common in the order elevated, depressed, and flat types. However, LNM was not significantly different based on gross appearance in undifferentiated EGC.

Conclusions

Clinical behavior differs according to endoscopic appearance in EGC. The endoscopic appearance of EGC may facilitate prediction of clinical behavior, particularly in differentiated EGC.

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Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0003347).

Disclosures

Drs. Da Hyun Jung, Yoo Mi Park, Jie-Hyun Kim, Yong Chan Lee, Young Hoon Youn, Hyojin Park, Sang In Lee, Jong Won Kim, Seung Ho Choi, Woo Jin Hyung, and Sung Hoon Noh have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea

    Da Hyun Jung, Yoo Mi Park, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park & Sang In Lee

  2. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, 135-720, Republic of Korea

    Jong Won Kim & Seung Ho Choi

  3. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, 120-752, Republic of Korea

    Yong Chan Lee

  4. Department of Surgery, Yonsei University College of Medicine, 50 Yonseiro, Seodaemungu, Seoul, 120-752, Republic of Korea

    Woo Jin Hyung & Sung Hoon Noh

Authors
  1. Da Hyun Jung
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  2. Yoo Mi Park
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  3. Jie-Hyun Kim
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  4. Yong Chan Lee
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  5. Young Hoon Youn
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  6. Hyojin Park
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  7. Sang In Lee
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  8. Jong Won Kim
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  9. Seung Ho Choi
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  10. Woo Jin Hyung
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  11. Sung Hoon Noh
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Corresponding author

Correspondence to Jie-Hyun Kim.

Additional information

D. H. Jung and Y. M. Park contributed equally to this work.

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Jung, D.H., Park, Y.M., Kim, JH. et al. Clinical implication of endoscopic gross appearance in early gastric cancer: revisited. Surg Endosc 27, 3690–3695 (2013). https://doi.org/10.1007/s00464-013-2947-y

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  • DOI: https://doi.org/10.1007/s00464-013-2947-y

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