Histological mixed-type as an independent risk factor for nodal metastasis in submucosal gastric cancer
- 106 Downloads
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.
KeywordsHistologically mixed-type Submucosal gastric cancer Lymph node metastasis Surrogate marker Japanese Classification of Gastric Cancer TNM staging
Conflict of interest
- 2.Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23. doi: 10.1007/s10120-011-0042-4.
- 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.CrossRefPubMedGoogle 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
- 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.CrossRefPubMedGoogle 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.Google Scholar
- 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
- 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.CrossRefPubMedGoogle Scholar