Gastric Cancer

, Volume 21, Issue 4, pp 661–671 | Cite as

Establishment of pathological quantitative method for determining undifferentiated component ratio in patients with differentiated/undifferentiated mixed-type early gastric cancer and clinical significance of this ratio

  • Hirohisa Takeuchi
  • Nobutsugu Abe
  • Yoshikazu Hashimoto
  • Atsuko Ooki
  • Gen Nagao
  • Kazuhiko Hirano
  • Yasuo Ookura
  • Tadahiko Masaki
  • Toshiyuki Mori
  • Masanori Sugiyama
Original Article



The purpose of this study was to establish a pathological quantitative method for determining the undifferentiated components ratio (UCR) in patients with differentiated/undifferentiated mixed-type (Mixed-type) early gastric cancer (EGC) and to examine the clinical significance.


The subjects were 410 patients who underwent surgical resection for EGC with the invasion limited to m or sm1. Analysis 1: In 12 randomly selected patients with Mixed-type cancer, we calculated the area ratio and the ratio of the length ratio using ImageJ and analyzed the correlation between them. Analysis 2: We generated ROC curves, and determined the cutoff UCR on the basis of the predictive risk factors for lymph node metastasis (LNM). Analysis 3: We analyzed the relationship between clinicopathological factors including UCR/length of undifferentiated component (LUC = maximum dimensions of tumor × UCR) and LNM.


Analysis 1: The length ratio can be used as a substitute parameter for the UCR (r = 0.996). Analysis 2: The cutoff UCR as a risk factor for LNM was 58% (sensitivity = 1, 1 − specificity = 0.404). Analysis 3: Lymphovascular invasion (p < 0.0001), UCR ≥58% (p = 0.023), and LUC ≥25 mm (p = 0.005) were identified as significant risk factors for LNM. No LNM was observed in patients with invasion limited to m or sm1 and negativity for lymphovascular invasion and UCR <58% (0/215).


In the patients with Mixed-type EGC, the length ratio of undifferentiated components can be a substitute parameter for the UCR. LNM rarely occurs in patients without lymphovascular invasion and with an UCR <58%. The analysis of the UCR has great significance in determining whether additional surgical resection is required after endoscopic resection.


Early gastric cancer Mixed-type Pathological quantitative method 



We sincerely thank Professor Koji Teruya of the Faculty of Health Sciences, Kyorin University, for his advice and cooperation with the statistical processing in this study. This study acknowledge the financial support of Setsuro Fujii Memorial The Osaka Foundation for Promotion of Fundamental Medical Research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017

Authors and Affiliations

  • Hirohisa Takeuchi
    • 1
  • Nobutsugu Abe
    • 1
  • Yoshikazu Hashimoto
    • 1
  • Atsuko Ooki
    • 1
  • Gen Nagao
    • 1
  • Kazuhiko Hirano
    • 2
  • Yasuo Ookura
    • 2
  • Tadahiko Masaki
    • 1
  • Toshiyuki Mori
    • 1
  • Masanori Sugiyama
    • 1
  1. 1.Department of SurgeryKyorin University School of MedicineMitakaJapan
  2. 2.Department of PathologyKyorin University School of MedicineMitakaJapan

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