Risk of lymph node metastasis in mixed-type early gastric cancer determined by the extent of the poorly differentiated component

Hwang, Chungsu; Ahn, Sang Ho; Lee, Bong-Eun; Lee, So-Jeong; Kim, Ahrong; Choi, Chang In; Kim, Dae Hwan; Jeon, Tae Yong; Kim, Gwang Ha; Song, Geum Am; Park, Do Youn

doi:10.3748/wjg.v22.i15.4020

Cited by 28 publications

(18 citation statements)

References 19 publications

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“…Previous reports showed the overall risk of LNM ranged from 1.4% to 5.2% for mucosal cancers, and 15% to 21.4% for submucosal cancers. [ 26 – 28 ] Although in our cohort, the LNM rate of early YGC rose up to 27.6% (8/29) for T1a lesions and 43.7% (7/16) for T1b lesions, which is much higher than that have been reported, the overall LNM risk in the older cohort was 13%, which is in agreement with previous studies. [ 29 ] Takatsu et al [ 5 ] reported that more YGC patients had involvement of 7 or more lymph nodes and suggested that the presence of LNM was a strong risk factor for their tumor recurrence and a strict follow-up should be adhered to for YGCs.…”

Section: Discussionsupporting

confidence: 92%

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Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Zhang

Wang

et al. 2017

Medicine

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This research aims to explore the potential risk factors of lymph node metastasis (LNM) for early gastric cancers in young patients.We retrospectively collected data from 4287 patients who underwent gastrectomy from January 2005 to December 2015 at Linyi People's Hospital. Of these, we enrolled 397 eligible consecutive patients who had early gastric cancer, then divided them into 2 groups according to age (≤40 years and >40 years). The association between the clinicopathological factors and LNM was analyzed by univariate and multivariate analysis.Compared to older patients (>40 years), younger patients (≤40 years) with early gastric cancer had more diffuse and mixed types (51.1% and 37.8% vs 40% and 8.3%, respectively), less proximal gastric cancer (0% vs 33.8%, P < .01) and higher LNM (33.3% vs 13%, P < .01). Univariate analysis showed tumor invasion depth (P < .01), lymphovascular invasion (P < .01), and E-cadherin expression (P = .024) were associated with LNM in the younger cohort. Multivariate analysis revealed that lymphovascular invasion (OR = 17.740, 95% CI: 1.458–215.843) was an independent risk factor for LNM (P = .024). Further analysis showed 3 patients who were within expanded endoscopic resection indications were positive for LNM.Given the high risk of lymph node involvement in young patients with early gastric cancer, both endoscopic and surgical resection procedures should be performed with caution, and active postoperative surveillance is warranted.

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Section: Discussionsupporting

confidence: 92%

“…Recently, studies [ 28 , 45 , 46 ] have focused on histological mixed-type, which was related to more aggressive biological behavior and poorer outcomes. In our study, 40% of early YGC had mixed-type, much higher than their older counterparts (40% vs 8%).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Zhang

Wang

et al. 2017

Medicine

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“…In early gastric adenocarcinomas combined with signet‐ring cell carcinoma (diffuse), the frequency of LNM is greatly increased to over 20%, as reported in single‐center cohorts from Korea, Japan, and China. This risk appears to be significantly associated with a large tumor size, more frequent submucosal infiltration and lymphovascular invasion .…”

Section: Discussionmentioning

confidence: 92%

“…In this multicenter study and previous single-center studies of Chinese patients, 8,10 the risk of LNM in early adenosquamous, neuroendocrine carcinomas, and carcinomas with lymphoid stroma, although there are few such studies, is minimal, as was also seen in Korean patients. 27 In early gastric adenocarcinomas combined with signet-ring cell carcinoma (diffuse), the frequency of LNM is greatly increased to over 20%, as reported in single-center cohorts from Korea, 28 Japan, 29,30 and China 10 . This risk appears to be significantly associated with a large tumor size, more frequent submucosal infiltration and lymphovascular invasion.…”

Section: In 2000mentioning

confidence: 96%

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

Chen

Wang

Cheng³

et al. 2017

J of Digest Diseases

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“…The 5-year EGC-speci c survival rate after surgical resection has been reported to be as high as 99% in patients with mucosal cancer and 96% in those with submucosal cancer [21]. However, several recent reports have indicated a difference in malignant potential between PD-EGC and MD-EGC [8][9][10][11][12][13][14][15][16]. Further, with respect to the long-term prognosis, mixed-type EGC cases with metastatic recurrence following an expanded curative endoscopic resection has been reported [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinicopathological Features and Long-Term Prognosis Between Mixed Predominantly Differentiated-Type and Pure Differentiated-Type Early Gastric Cancer

Okagawa

Sumiyoshi

Kondo

et al. 2020

Preprint

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Background: Recent studies have shown that mixed predominantly differentiated-type (MD) early gastric cancer (EGC) might have more malignant potential than pure differentiated-type (PD) EGC. However, no study has analyzed all differentiated-type EGC cases treated endoscopically and surgically. This study aimed to compare the differences in clinicopathological features and long-term prognosis between MD- and PD-EGC. Methods: We evaluated all patients with differentiated-type EGCs who were treated endoscopically and surgically in our hospital between January 2010 and October 2014. The clinicopathological features and long-term prognosis of MD-EGC were compared with those of PD-EGC.Results: A total of 459 patients with 459 lesions were evaluated in this study; of them, 409 (89.1%) and 50 (10.9%) were classified into the PD and MD group, respectively. Submucosal invasion was found in 96 (23.5%) of the PD group and in 33 (66.0%) of the MD group (p<0.01). The rates of positive lymphatic and vascular invasion and ulceration were significantly higher in the MD group than in the PD group (p<0.01). The proportion of patients with lymph node metastasis was also significantly higher in the MD group than in the PD group (5 (10%) vs 6 (1.5%), p<0.01). The 5-year overall and EGC-specific survival rates in the PD were 88.3% and 99.5%, respectively, while they were 94.0% and 98.0% in the MD group, respectively. Conclusions: MD-EGC has more malignant potential than PD-EGC. However, the long-term prognosis of MD-EGC is good and is not significantly different from that of PD-EGC when treated appropriately.

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Risk of lymph node metastasis in mixed-type early gastric cancer determined by the extent of the poorly differentiated component

Abstract: We recommend careful identification and quantitative evaluation of mixed-type early gastric cancer components after endoscopic resection to determine the intensity of the treatment.

Cited by 28 publications

References 19 publications

Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

Comparison of Clinicopathological Features and Long-Term Prognosis Between Mixed Predominantly Differentiated-Type and Pure Differentiated-Type Early Gastric Cancer

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