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Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 772–777 | Cite as

Poorly Differentiated Carcinoma Component in Submucosal Layer Should be Considered as an Additional Criterion for Curative Endoscopic Resection of Early Gastric Cancer

  • Da Hyun Jung
  • Yoon Sung Bae
  • Sun Och Yoon
  • Yong Chan Lee
  • Hoguen Kim
  • Sung Hoon Noh
  • Hyojin Park
  • Seung Ho Choi
  • Jie-Hyun KimEmail author
  • Hyunki KimEmail author
Gastrointestinal Oncology

Abstract

Background

Some studies have reported lymph node metastasis (LNM) in early gastric cancer (EGC) cases meeting the expanded criteria for endoscopic resection. Therefore, we investigated whether a minor poorly differentiated carcinoma (PDC) component in the submucosal (SM) layer affects LNM in differentiated EGC.

Methods

We performed surgery in 1096 patients with differentiated SM gastric cancer and compared the clinicopathologic features of node-positive (n = 194) and node-negative (n = 902) differentiated SM cancer, with special reference to the portion of PDC component in the SM layer.

Results

When we categorized patients by the proportion of PDC component in the SM layer, we found 840 patients had <5 % and 256 patients had ≥5 % PDC components in the SM layer. The ≥5 % group was significantly associated with younger age, female sex, moderate differentiation, deep SM invasion, lymphovascular invasion (LVI), perineural invasion, and LNM. In multivariate analysis, middle third location, moderate differentiation, SM2 invasion, size >2 cm, LVI, and PDC components in the SM layer were independent risk factors for LNM. When we limited the depth of invasion to SM1, the incidence of LNM was significantly higher in the ≥5 % group. On multivariate analysis, tumor size >2 cm, moderate differentiation, LVI positivity, and ≥5 % PDC components in the SM1 layer were independent risk factors for LNM in SM1 cancer.

Conclusions

The PDC component in the SM layer of differentiated EGC was an independent risk factor of LNM, which might constitute a supplementary criterion in the expanded indications for endoscopic resection in differentiated EGC.

Keywords

Gastric Cancer Lymph Node Metastasis Early Gastric Cancer Endoscopic Resection Perineural Invasion 
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

Supported in part by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2012R1A1A1042417 and 2012R1A1A1004403).

Disclosure

Da Hyun Jung, Yoon Sung Bae, Sun Och Yoon, Yong Chan Lee, Hoguen Kim, Sung Hoon Noh, Hyojin Park, Seung Ho Choi, Jie-Hyun Kim, and Hyunki Kim have nothing to disclosure.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Da Hyun Jung
    • 1
    • 2
  • Yoon Sung Bae
    • 3
  • Sun Och Yoon
    • 3
  • Yong Chan Lee
    • 1
  • Hoguen Kim
    • 3
  • Sung Hoon Noh
    • 4
  • Hyojin Park
    • 1
    • 2
  • Seung Ho Choi
    • 2
    • 4
  • Jie-Hyun Kim
    • 1
    • 2
    Email author
  • Hyunki Kim
    • 3
    Email author
  1. 1.Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  2. 2.Gangnam Severance HospitalSeoulKorea
  3. 3.Department of PathologyYonsei University College of MedicineSeoulKorea
  4. 4.Department of SurgeryYonsei University College of MedicineSeoulKorea

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