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01-01-2016 | Original Article

Histological mixed-type as an independent risk factor for nodal metastasis in submucosal gastric cancer

Authors: Mahito Miyamae, Shuhei Komatsu, Daisuke Ichikawa, Toshiyuki Kosuga, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Mitsuo Kishimoto, Eigo Otsuji

Published in: Tumor Biology | Issue 1/2016

Abstract

Recent studies reported that the histological mixed-type, which consists of differentiated and undifferentiated components, was related to the aggressive clinical features of gastric cancer as well as its poor outcomes. This study was designed to investigate the influences of the mixed-type on lymph node metastasis in patients with submucosal gastric cancer. We analyzed a total of 239 consecutive patients who underwent curative gastrectomy for submucosal gastric cancer between 2004 and 2012 from their hospital records. The overall prevalence of histological mixed-type in submucosal gastric cancer was 46.9 % (112/239). The histological mixed-type correlated more strongly with lymph node metastasis (P = 0.0016; 25.0 % (28/112)) than the undifferentiated type in the Japanese classification of gastric carcinoma (JCGC) (P = 0.2779; 20.5 % (17/83)) and 7th tumor-node-metastasis (TNM) (P = 0.0476; 20.7 % (31/150)) classifications. Univariate and multivariate logistic regression analyses identified a tumor size of 25 mm or greater (P = 0.0003, OR 4.51 (95 % CI 1.95–11.9)) and the histological mixed-type (P = 0.0316, OR 4.02 (95 % CI 1.12–19.2)) as independent risk factors for lymph node metastasis. The incidence of lymph node metastasis was high in patients with both these factors (33.8 % (23/68)) and low in patients without both factors (3.0 % (2/67)). These results suggest that the histological mixed-type correlated more strongly with lymph node metastasis than the undifferentiated type in the JCGC and TNM classifications and highlight its usefulness as a risk factor for lymph node metastasis in submucosal gastric cancer.

Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002;5(1):1–5. doi:10.1007/s101200200000.CrossRefPubMed

Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23. doi:10.1007/s10120-011-0042-4.

Popiela T, Kulig J, Kolodziejczyk P, Sierzega M. Long-term results of surgery for early gastric cancer. Br J Surg. 2002;89(8):1035–42. doi:10.1046/j.1365-2168.2002.02156.x.CrossRefPubMed

Gotoda T, Sasako M, Ono H, Katai H, Sano T, Shimoda T. Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancer. Br J Surg. 2001;88(3):444–9. doi:10.1046/j.1365-2168.2001.01725.x.CrossRefPubMed

Folli S, Morgagni P, Roviello F, De Manzoni G, Marrelli D, Saragoni L, et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC). Jpn J Clin Oncol. 2001;31(10):495–9.CrossRefPubMed

Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12. doi:10.1007/s10120-011-0041-5.

Sobin LGM, Wittekind C, editors. International union against cancer. TNM classification of malignant tumours. 7th ed. New York: Wiley-Blackwell; 2010.

Nakamura K, Sugano H, Takagi K. Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gan. 1968;59(3):251–8.PubMed

Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31–49.PubMed

10.

Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3(4):219–25.CrossRefPubMed

11.

Hanaoka N, Tanabe S, Mikami T, Okayasu I, Saigenji K. Mixed-histologic-type submucosal invasive gastric cancer as a risk factor for lymph node metastasis: feasibility of endoscopic submucosal dissection. Endoscopy. 2009;41(5):427–32. doi:10.1055/s-0029-1214495.CrossRefPubMed

12.

Ito H, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, et al. Clinicopathological characteristics and treatment strategies in early gastric cancer: a retrospective cohort study. J Exp Clin Cancer Res. 2011;30:117. doi:10.1186/1756-9966-30-117.CrossRefPubMedPubMedCentral

13.

Takizawa K, Ono H, Kakushima N, Tanaka M, Hasuike N, Matsubayashi H, et al. Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection. Gastric Cancer. 2013;16(4):531–6. doi:10.1007/s10120-012-0220-z.CrossRefPubMed

14.

Tanabe H, Iwashita A, Haraoka S. Clinicopathological characteristics of differentiated mixed-type early gastric carcinoma with lymph node metastasis [in Japanese with English abstract]. Stom Int. 2007;42:1561–76.

15.

Watanabe GAY, Kato T. Pathological characteristics of differentiated-type early gastric carcinoma mixed with undifferentiated-type-Status of lymph node metastasis and macroscopic features [in Japanese with English abstract]. Stom Int. 2007;42:1577–87.

16.

Zheng HC, Li XH, Hara T, Masuda S, Yang XH, Guan YF, et al. Mixed-type gastric carcinomas exhibit more aggressive features and indicate the histogenesis of carcinomas. Virchows Arch. 2008;452(5):525–34. doi:10.1007/s00428-007-0572-7.CrossRefPubMedPubMedCentral

17.

Shimizu H, Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, et al. The decision criterion of histological mixed type in “T1/T2” gastric carcinoma—comparison between TNM classification and Japanese Classification of Gastric Cancer. J Surg Oncol. 2012;105(8):800–4. doi:10.1002/jso.23010.CrossRefPubMed

18.

Huh CW, da Jung H, Kim JH, Lee YC, Kim H, Kim H, et al. Signet ring cell mixed histology may show more aggressive behavior than other histologies in early gastric cancer. J Surg Oncol. 2013;107(2):124–9. doi:10.1002/jso.23261.CrossRefPubMed

19.

Zhu Z, Sun X, Wang J, Sun Z, Wang Z, Zheng X, et al. Histopathology-based prognostic score is independent prognostic factor of gastric carcinoma. BMC Cancer. 2014;14:663. doi:10.1186/1471-2407-14-663.CrossRefPubMedPubMedCentral

20.

Komatsu S, Ichikawa D, Miyamae M, Shimizu H, Konishi H, Shiozaki A, et al. Histological mixed-type as an independent prognostic factor in stage I gastric carcinoma. World J Gastroenterol. 2015;21(2):549–55. doi:10.3748/wjg.v21.i2.549.CrossRefPubMedPubMedCentral

21.

Park SY, Kook MC, Kim YW, Cho NY, Kim TY, Kang GH. Mixed-type gastric cancer and its association with high-frequency CpG island hypermethylation. Virchows Arch. 2010;456(6):625–33. doi:10.1007/s00428-010-0916-6.CrossRefPubMed

Title: Histological mixed-type as an independent risk factor for nodal metastasis in submucosal gastric cancer
Authors: Mahito Miyamae
Shuhei Komatsu
Daisuke Ichikawa
Toshiyuki Kosuga
Takeshi Kubota
Kazuma Okamoto
Hirotaka Konishi
Atsushi Shiozaki
Hitoshi Fujiwara
Mitsuo Kishimoto
Eigo Otsuji
Publication date: 01-01-2016
Publisher: Springer Netherlands
Published in: Tumor Biology / Issue 1/2016
Print ISSN: 1010-4283
Electronic ISSN: 1423-0380
DOI: https://doi.org/10.1007/s13277-015-3864-6

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