Gastric Cancer

, Volume 21, Issue 4, pp 689–695 | Cite as

Mixed poorly differentiated adenocarcinoma in undifferentiated-type early gastric cancer predicts endoscopic noncurative resection

  • Yusuke Horiuchi
  • Junko Fujisaki
  • Noriko Yamamoto
  • Naoki Ishizuka
  • Masami Omae
  • Akiyoshi Ishiyama
  • Toshiyuki Yoshio
  • Toshiaki Hirasawa
  • Yorimasa Yamamoto
  • Masatsugu Nagahama
  • Hiroshi Takahashi
  • Tomohiro Tsuchida
Original Article



Comparisons between surgical cases of mixed poorly differentiated adenocarcinoma and pure signet ring cell carcinoma have revealed higher frequencies of lymph node metastasis and submucosal invasion in the former. However, this comparison has not been reported for endoscopically treated cases. Therefore, we compared cases of curative and noncurative resection in patients who underwent endoscopic submucosal dissection to determine what factors could influence the curative resection rate.


We analyzed 268 undifferentiated-type early gastric cancers in 264 patients treated with endoscopic submucosal dissection in our hospital between March 2005 and March 2017, involving 229 and 39 cases of curative and noncurative resection, respectively. Treatment results were compared between 129 lesions of pure signet ring cell carcinoma and 139 lesions of mixed poorly differentiated adenocarcinoma.


The overall curative resection rate was 85.4% (229/268). On comparing noncurative and curative resection cases, after excluding factors that determine curative resection (e.g., tumor diameter), we found that the former was associated with older age and significantly more mixed poorly differentiated adenocarcinomas, with odds ratios of 1.052 [95% confidence interval (CI), 1.017–1.089] and 2.746 (95% CI, 1.162–6.485), respectively, on multivariate analysis. The curative resection rate was significantly higher in pure signet ring cell carcinoma than in mixed poorly differentiated adenocarcinoma (93.8% vs. 77.7%, respectively).


Advanced age and mixed poorly differentiated adenocarcinoma predicted endoscopic noncurative resection.


Endoscopic resection Gastric cancer Poorly differentiated adenocarcinoma Signet ring cell carcinoma 


Compliance with ethical standards

Conflict of interest

There is no conflict of interest in this study.

Human rights statement and informed consent

This study was conducted in compliance with the principle of the “Declaration of Helsinki” issued in 1964 and revised thereafter. Before registration, all personal identifiers were deleted, and informed consent was obtained from all patients to allow the use of pathological specimens and imaging data for this study. The study has been approved by the institutional review board at the Cancer Institute Hospital (IRB no.2017-1033).


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Copyright information

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

Authors and Affiliations

  • Yusuke Horiuchi
    • 1
  • Junko Fujisaki
    • 1
  • Noriko Yamamoto
    • 2
  • Naoki Ishizuka
    • 3
  • Masami Omae
    • 1
  • Akiyoshi Ishiyama
    • 1
  • Toshiyuki Yoshio
    • 1
  • Toshiaki Hirasawa
    • 1
  • Yorimasa Yamamoto
    • 4
  • Masatsugu Nagahama
    • 4
  • Hiroshi Takahashi
    • 4
  • Tomohiro Tsuchida
    • 1
  1. 1.Department of GastroenterologyCancer Institute HospitalTokyoJapan
  2. 2.Department of PathologyCancer Institute HospitalTokyoJapan
  3. 3.Department of Clinical Trial planning and ManagementCancer Institute HospitalTokyoJapan
  4. 4.Department of GastroenterologyShowa University Fujigaoka HospitalYokohamaJapan

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