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Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1813–1819 | Cite as

Risk of Lymph Node Metastasis in Differentiated Type Mucosal Early Gastric Cancer Mixed with Minor Undifferentiated Type Histology

  • Jun Ho Lee
  • Il Ju Choi
  • Hye Seung Han
  • Young-Woo Kim
  • Keun Won Ryu
  • Hong Man Yoon
  • Bang Wool Eom
  • Chan Gyoo Kim
  • Jong Yeul Lee
  • Soo-Jeong Cho
  • Young-Il Kim
  • Byung-Ho Nam
  • Myeong-Cherl KookEmail author
Gastrointestinal Oncology

Abstract

Background

The possibility of lymph node metastasis is critical to the assessment of the indication for endoscopic submucosal dissection. The differentiation of tumors is an important predicting factor for lymph node metastasis. Even though gastric cancers frequently show intratumoral heterogeneity, most studies have not considered the effects of the minor histologic components. The purpose of this study was to investigate the relationship between the presence of undifferentiated type histology (UD-min) within differentiated type tumors and lymph node metastases in early gastric cancer confined to the mucosal layer.

Methods

A retrospective study of 847 patients who underwent surgery for differentiated early gastric cancer, confined to mucosa, was conducted. We analyzed the proportion of the undifferentiated type components of the tumor and their relationship with lymph node metastasis.

Results

The overall rate of lymph node metastasis was 1.7 % (14/847 patients) and 215 differentiated tumors (25.4 %) have UD-min. UD-min was associated with female sex, younger age, larger tumor size, and the presence of ulcer. Lymph node metastasis rate with or without UD-min was 5.1 % (11/215) versus 0.5 % (3/632), respectively (p < 0.001). UD-min was found to be associated with lymph node metastasis in the multivariate analyses (odds ratio [OR] = 4.39, CI 1.08–17.89). When three risk factors (tumor size >2 cm, ulcer, and UD-min) were present concurrently, the rate of lymph node metastasis was high (10 %).

Conclusions

The presence of an UD-min component should be considered when assessing curative resection status of endoscopic submucosal dissection for differentiated type mucosal cancer.

Keywords

Gastric Cancer Endoscopic Submucosal Dissection Early Gastric Cancer Lymphovascular Invasion Mucosal Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This work was supported by a grant from the National Cancer Center (NCC-1110240).

Disclosure

The authors declare no competing interests.

Supplementary material

10434_2014_4167_MOESM1_ESM.tif (24.6 mb)
Supplemental Fig. 1 Pathologic classification. A Differentiated type adenocarcinoma without undifferentiated component. B Differentiated type adenocarcinoma mixed with undifferentiated component
10434_2014_4167_MOESM2_ESM.tif (25.9 mb)
Supplemental Fig. 2 Representative cases of ulcer. The whole thickness of muscularis mucosa was disrupted and replaced by fibrosis or irregular muscle bundles. A Disruption was focal and well demarcated. B Large-sized disruption was present
10434_2014_4167_MOESM3_ESM.tif (24.8 mb)
Supplementary material 3 (TIFF 25360 kb)
10434_2014_4167_MOESM4_ESM.tif (24.2 mb)
Supplementary material 4 (TIFF 24811 kb)

References

  1. 1.
    Jung K-W, Won Y-J, Kong H-J, Oh C-M, Seo HG, Lee J-S. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013;45(1):1–14.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Kunisaki C, Ishino J, Nakajima S, et al. Outcomes of mass screening for gastric carcinoma. Ann Surg Oncol. 2006;13(2):221–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Kim JP. Surgical results in gastric cancer. Paper presented at: Seminars in Surgical Oncology; 1999.Google Scholar
  4. 4.
    Jeong O, Park Y-K. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011;11(2):69–77.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005;23(20):4490–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N, Group JLSS. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245(1):68.CrossRefGoogle Scholar
  7. 7.
    Habermann CR, Weiss F, Riecken R, et al. Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US 1. Radiology. 2004;230(2):465–71.CrossRefPubMedGoogle Scholar
  8. 8.
    Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58(3):331–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Goto O, Fujishiro M, Kodashima S, Ono S, Omata M. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy. 2009;41(02):118–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. World Health Organization; 2010.Google Scholar
  11. 11.
    Association JGC. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRefGoogle Scholar
  12. 12.
    Saito A, Shimoda T, Nakanishi Y, Ochiai A, Toda G. Histologic heterogeneity and mucin phenotypic expression in early gastric cancer. Pathol Int. 2001;51(3):165–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M, Costa N, Lopes C, Moreira-Dias L. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc. 2009;69(2):350–5.CrossRefPubMedGoogle Scholar
  14. 14.
    An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007;246(5):749–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5(1):1–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Hoboken: Wiley; 2011.Google Scholar
  17. 17.
    Kim Y-W, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248(5):721–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Morii Y, Arita T, Shimoda K, et al. Jejunal interposition to prevent postgastrectomy syndromes. Br J Surg. 2000;87(11):1576–79.CrossRefPubMedGoogle Scholar
  19. 19.
    Morita S, Katai H, Saka M, Fukagawa T, Sano T, Sasako M. Outcome of pylorus‐preserving gastrectomy for early gastric cancer. Br J Surg. 2008;95(9):1131–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Takizawa K, Ono H, Kakushima N, 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. 2012; 16:531–536.CrossRefPubMedGoogle Scholar
  21. 21.
    Min B-H, Kim K-M, Park CK, et al. Outcomes of endoscopic submucosal dissection for differentiated-type early gastric cancer with histological heterogeneity. Gastric Cancer. 2014; 1–9. doi: 10.1007/s10120-014-0378-7.
  22. 22.
    Mita T, Shimoda T. Risk factors for lymph node metastasis of submucosal invasive differentiated type gastric carcinoma: clinical significance of histological heterogeneity. J Gastroenterol. 2001;36(10):661–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hanaoka N, Tanabe S, Mikami T, Okayasu I, Saigenji K. Mixed-histologic-type submucosal invasive gastric cancer as a risk factor for lymph node metastasis: feasibility of endoscopic submucosal dissection. Endoscopy. 2009;41(05):427–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Zheng H-c, Li X-h, Hara T, et al. Mixed-type gastric carcinomas exhibit more aggressive features and indicate the histogenesis of carcinomas. Virchows Arch. 2008;452(5):525–34.Google Scholar
  25. 25.
    Carneiro F. Classification of gastric carcinomas. Curr Diagn Pathol. 1997;4(1):51–9.CrossRefGoogle Scholar
  26. 26.
    Association JGC. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.CrossRefGoogle Scholar
  27. 27.
    Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3(4):219–25.CrossRefPubMedGoogle Scholar
  28. 28.
    Choi J, Kim S, Im J, Kim J, Jung H, Song I. Comparison of endoscopic ultrasonography and conventional endoscopy for prediction of depth of tumor invasion in early gastric cancer. Endoscopy. 2010;42(09):705–13.CrossRefPubMedGoogle Scholar
  29. 29.
    Higashimaya M, Oka S, Tanaka S, et al. Outcome of endoscopic submucosal dissection for gastric neoplasm in relationship to endoscopic classification of submucosal fibrosis. Gastric Cancer. 2012:1–7.Google Scholar
  30. 30.
    Haruta H, Hosoya Y, Sakuma K, et al. Clinicopathological study of lymph‐node metastasis in 1389 patients with early gastric cancer: assessment of indications for endoscopic resection. J Digest Dis. 2008;9(4):213–8.CrossRefGoogle Scholar
  31. 31.
    Kang HJ, Kim DH, Jeon T-Y, et al. Lymph node metastasis from intestinal-type early gastric cancer: experience in a single institution and reassessment of the extended criteria for endoscopic submucosal dissection. Gastrointest Endosc. 2010;72(3):508–15.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Jun Ho Lee
    • 1
    • 4
  • Il Ju Choi
    • 1
  • Hye Seung Han
    • 2
  • Young-Woo Kim
    • 1
  • Keun Won Ryu
    • 1
  • Hong Man Yoon
    • 1
  • Bang Wool Eom
    • 1
  • Chan Gyoo Kim
    • 1
  • Jong Yeul Lee
    • 1
  • Soo-Jeong Cho
    • 1
  • Young-Il Kim
    • 1
  • Byung-Ho Nam
    • 3
  • Myeong-Cherl Kook
    • 1
    Email author
  1. 1.Center for Gastric Cancer/Department of PathologyNational Cancer CenterGoyang-siRepublic of Korea
  2. 2.Department of PathologyKonkuk University School of MedicineSeoulKorea
  3. 3.Biometric Research BranchNational Cancer CenterGoyang-siKorea
  4. 4.Department of SurgerySungkyungkwan University School of MedicineSeoulKorea

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