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



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.


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.


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 %).


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


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.



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


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)


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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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