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

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• 作者：Jun Ho Lee ; Il Ju Choi ; Hye Seung Han ; Young-Woo Kim…
• 刊名：Annals of Surgical Oncology
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：22
• 期：6
• 页码：1813-1819
• 全文大小：409 KB
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• 作者单位：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)
  
  1. Center for Gastric Cancer/Department of Pathology, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
  4. Department of Surgery, Sungkyungkwan University School of Medicine, Seoul, Korea
  2. Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
  3. Biometric Research Branch, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
  
• 刊物主题：Surgical Oncology; Oncology; Surgery;
• 出版者：Springer US
• ISSN：1534-4681

文摘

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 1.08-7.89). 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.