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Early gastric cancer with a mixed-type Lauren classification is more aggressive and exhibits greater lymph node metastasis

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Abstract

Background

The clinicopathological features of mixed-type (MT) early gastric cancer (EGC) according to Lauren’s classification remain uninvestigated. This study aimed to clarify the clinicopathological features of MT EGC, particularly in relation to lymph node metastasis (LNM) and long-term survival.

Methods

This study included 5309 patients who underwent gastrectomy for EGC. The clinicopathological features, LNM, and long-term outcomes of patients with MT carcinomas were compared with those of patients with intestinal-type (IT) and diffuse-type (DT) cancers. Furthermore, we evaluated the predictors of LNM in each Lauren classification subgroup.

Results

Patients with MT carcinomas were likelier to have larger tumors, submucosal invasion, lymphovascular invasion, and LNM than those with IT or DT carcinomas. Multivariate logistic regression analysis revealed that the Lauren classification was a significant predictor of LNM (P < 0.001). The significant predictors of LNM in MT carcinomas were female sex, greater tumor size, presence of submucosal invasion, and lymphovascular invasion. However, the overall survival of patients with MT carcinoma was not significantly different from that of patients with IT or DT carcinomas (P = 0.104).

Conclusions

The presence of MT EGC carries a higher risk of LNM compared with the presence of IT or DT carcinomas. Therefore, MT carcinomas should be managed with gastrectomy that includes lymph node dissection instead of endoscopic resection.

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Author notes

    Authors and Affiliations

    1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

      Jeung Hui Pyo, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee & Jae J. Kim

    2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea

      Min Gew Choi, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae & Sung Kim

    3. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea

      Kyoung-Mee Kim

    4. Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

      Seungmin Yeon & Sin-Ho Jung

    5. Department of Biostatistics and Bioinformatics, Duke University, Durham, USA

      Sin-Ho Jung

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    1. Jeung Hui Pyo
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    2. Hyuk Lee
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    Corresponding authors

    Correspondence to Jun Ho Lee or Kyoung-Mee Kim.

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    The authors declare that they have no conflict of interest.

    Additional information

    J. H. Pyo and H. Lee contributed equally to this work.

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    Pyo, J.H., Lee, H., Min, BH. et al. Early gastric cancer with a mixed-type Lauren classification is more aggressive and exhibits greater lymph node metastasis. J Gastroenterol 52, 594–601 (2017). https://doi.org/10.1007/s00535-016-1254-5

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    • DOI: https://doi.org/10.1007/s00535-016-1254-5

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