Abstract
BackgroundHistological differentiated/undifferentiated mixed-type adenocarcinomas are frequently found in patients with early gastric cancer (EGC). Yet it is unclear whether these mixed-type adenocarcinomas can be treated by endoscopic resection (ER) in EGC patients.AimsTo evaluate the lymph node metastasis (LNM) rate and long-term outcomes in mixed-type EGC patients and assess the feasibility of ER in these patients.MethodsClinicopathological features, risk factors of LNM, and overall survival (OS) and progression-free survival (PFS) rates of EGC patients were analyzed according to different histological types.ResultsPatients with mixed-type EGC had higher LNM rates than patients with non-mixed-type EGC (11.4 vs. 6.2%, P = 0.044). In the multivariate analysis, larger tumor diameter, presence of an ulcer, submucosal invasion, histological undifferentiated type, histological mixed type, and lymphovascular invasion resulted as independent risk factors for LNM in EGC patients (all P < 0.05). The LNM rate in mixed-type patients who met the Japanese ER criteria was 3.3%, including fulfilling the absolute criteria 0%. The 5-year OS and PFS rates in mixed-type patients were 94.59 and 91.47%, respectively. There was no statistical significance in the OS (P = 0.870) and PFS (P = 0.705) between mixed-type and non-mixed-type EGC patients fulfilling the Japanese ER criteria.ConclusionHistological differentiated/undifferentiated mixed type in EGC patients meeting the Japanese absolute criteria for ER are associated with low risk of LNM and favorable prognosis, and thus, it should not be considered as a non-curative factor for ER.
Highlights
Gastric cancer (EGC) can be histologically classified into differentiated and undifferentiated types [1]; the former contains well or moderately differentiated papillary/tubular adenocarcinoma
Mixed-type Early gastric cancer (EGC) tumors were associated with younger age (P = 0.000), female gender (P = 0.000), larger tumor diameter (P = 0.020), more located at the body of the stomach (P = 0.000), more flat macroscopic appearance (P = 0.000), more positive lymph node metastasis (LNM) (P = 0.001), higher pN stage (P = 0.004), and higher pTNM stage (P = 0.004) compared to non-mixed-type EGC tumors
No lymph node metastasis was found in the Lymphovascular invasion (LVI) negative patients
Summary
Gastric cancer (EGC) can be histologically classified into differentiated and undifferentiated types [1]; the former contains well or moderately differentiated papillary/tubular adenocarcinoma. The latter contains poorly differentiated/signet-ring cell/mucinous adenocarcinoma. In addition to these histological types, the differentiated/undifferentiated mixed-type adenocarcinomas, which refer to the intermingled histopathology of differentiated and undifferentiated adenocarcinoma components, are frequently observed in EGC patients [2]. Histological differentiated/undifferentiated mixed-type adenocarcinomas are frequently found in patients with early gastric cancer (EGC). It is unclear whether these mixed-type adenocarcinomas can be treated by endoscopic resection (ER) in EGC patients
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