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Diagnostic Pathology

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Open Access 01-12-2021 | Gastric Cancer | Research

Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

Authors: Zhi-Yi Zhou, Jie Sun, Qing Guo, Hai-Bin Zhao, Zhi-Hua Zhou

Published in: Diagnostic Pathology | Issue 1/2021

Abstract

Background

Certain gastric cancers exhibit some primitive phenotypes, which may indicate a high malignancy. In histologically differentiated early gastric cancer (EGC), the presence and the clinicopathological significance of the primitive phenotype remain unclear.

Methods

Using immunohistochemical staining we detected the expression of three primitive phenotypic markers SALL4, Glypican-3(GPC3), and AFP in whole tissue sections of differentiated EGC (gastrectomy specimens, n = 302). For those cases with primitive phenotypes, we analyzed their clinicopathological features and evaluated whether the criteria for endoscopic resection were met.

Results

We found that 9.3% (28/302) of all differentiated EGC cases have primitive phenotypes, and most of these cases (25/28) exhibit a histomorphology similar to conventional differentiated EGC. Patients with primitive phenotypes had a deeper invasion, a higher rate of ulcer and lymphatic invasion than cases without primitive phenotype. Moreover, patients with primitive phenotypes displayed a significantly higher frequency of LNM than those without (57.1% vs 8.8%, P < 0.001). Multivariate analysis revealed that presence of primitive phenotypes was an independent risk factor for LNM (P = 0.001, HR 6.977, 95% CI: 2.199–22.138). Interestingly, we found 2 cases with primitive phenotypes developed LNM, and they both met the expanded indications of endoscopic resection for differentiated EGC.

Conclusions

A small number of differentiated EGC have primitive phenotypes, which were closely related to LNM and were an independent risk factor for LNM. Given its highly aggressive behavior, differentiated EGC with primitive phenotypes should be evaluated with stricter criteria before endoscopic resection, or considered to give an additional surgical operation after endoscopic resection.

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Title: Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology
Authors: Zhi-Yi Zhou
Jie Sun
Qing Guo
Hai-Bin Zhao
Zhi-Hua Zhou
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Gastric Cancer
Gastric Cancer
Published in: Diagnostic Pathology / Issue 1/2021
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-021-01128-w

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Springer Medicine

Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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