Abstract
The use of endoscopic techniques to cure small sized, well differentiated early gastric cancer has been adopted worldwide. In the Eastern world, endoscopic resection is being increasingly utilized to treat small undifferentiated early gastric cancer according to the extended criteria proposed by the Japanese Gastric Cancer Associations. However, studies in the Western world reported in these tumors a rate of nodal metastasis ranging between 5% and 20%, that is higher of those observed in Eastern counterparts. A tool to predict the risk of nodal dissemination would be of great use to guide treatment toward endoscopic resection. In our study, we propose E-cadherin expression as a biological factor to predict lymph node involvement. We retrospectively reviewed the E-cadherin (E-cad) expression profile of all histological specimens of undifferentiated early gastric cancer from two Oncologic Departments and compared it with several tumor characteristics. A total of 39 patients with early gastric cancer met the inclusion criteria, of which 16 (41%) pT1a, and 23 (58.9%) pT1b SM1. Thirty-two patients (82%) underwent subtotal gastrectomy, whereas total gastrectomy was performed in only seven cases (17.9%). Patients were divided into two groups: low E-cad expression (E-cad 0/1+, 10 patients) and high E-cad expression (E-cad 2+/3+, 29 patients) according to the immunohistochemical assay (ICH). On univariate analysis, we found an association between low E-cad expression and low grading tumor (p = 0.019), pure undifferentiated histotype (PU-type) (p = 0.014), and lymph node involvement (N+) (p < 0.001). The association between low E-cad expression and lymph node metastasis was confirmed by multivariate analysis (OR = 14.5, 95% CI 3.46-60.76, p < 0.001). The loss of expression of E-cad may be a simple biological factor to predict lymph nodes metastasis in patients with undifferentiated early gastric cancer. Additional larger prospective studies are necessary to confirm these findings.
Highlights
Gastric cancer (EGC) is defined as a gastric cancer (GC) confined to the mucosa or the submucosa irrespective of lymph node metastasis (LNM)
We found an association between low E-cad expression and low grading tumor (p = 0.019), pure undifferentiated histotype (PU-type) (p = 0.014), and lymph node involvement (N+) (p < 0.001)
We retrospectively reviewed the medical records of all the patients who were treated for gastric cancer at two large referral institutions between October 2015 and October 2019 All patients with undifferentiated pT1a or pT1b (SM1 < 500 μm from the muscularis mucosae) Early gastric cancer (EGC) were included in the study and their histological specimens were tested for E-cadherin expression profile
Summary
Gastric cancer (EGC) is defined as a gastric cancer (GC) confined to the mucosa (pT1a) or the submucosa (pT1b) irrespective of lymph node metastasis (LNM). It bears a more favorable prognosis after conventional gastrectomy with nodal dissection compared to advanced gastric cancer cases [1]. The Japanese Gastric Cancer Associations guidelines [4] proposed two different sets of endoscopic resections: standard and expanded. Both procedures are considered curative when all of the following conditions are met: en-bloc resection, negative horizontal margin (HM0), negative vertical margin (VM0), and absence of lympho-vascular infiltration
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