Non-mucinous Gastric Carcinoma Research Articles

Clinical Outcomes of Mucinous Gastric Carcinomas Compared with Non-mucinous and Signet Ring Cell Carcinomas.

This study examined the clinical features and prognosis of patients with mucinous gastric carcinoma (MGC), non-mucinous gastric carcinoma (NMGC), and signet ring cell gastric carcinoma (SRC). A retrospective cohort study was performed, enrolling 65 patients with MGC from January 2007 to December 2016. During the same period, 1,814 patients with histologically proven gastric cancers underwent curative or palliative operations. One hundred and ninety-five NMGC patients were selected as the 1:3 age- and sex-matched control groups. In addition, 200 SRC patients were identified. This study evaluated the demographic features of the patients, pathologic features of the tumor, and the predictive factors, such as the recurrence-free survival and overall survival. The recurrence rates were significantly high in MGC than in NMGC or SRC (both p<0.01). The proportion of early gastric cancer was lower in the MGC group than in the other groups (p<0.01). In addition, metastatic lymph nodes were found more frequently in the MGC group (p<0.01), and the proportion of initial pT4, M1 stage, was highest in the MGC group. The recurrence-free survival and overall survival in the MGC group were significantly lower than those in the NMGC or SRC. Subgroup analysis showed that patients with the same American Joint Committee on Cancer (AJCC) stage of each cancer group showed a similar prognosis. MGC frequently presents an advanced stage with an unfavorable prognosis compared to NMGC or SRC. On the other hand, MGC of the same AJCC stage had a similar prognosis to NMGC and SRC.

Mucinous adenocarcinoma and non-mucinous adenocarcinoma: differing clinicopathological characteristics and computed tomography features in gastric cancer.

Mucinous gastric carcinoma (MGC) is a rare histological subtype of gastric cancer. The clinicopathological characteristics and CT features of MGC remain controversial. This study aimed to determine the clinicopathological characteristics and CT features of MGC. We reviewed 62 patients with MGC and 104 patients with non-mucinous gastric carcinoma (NMGC), pathologically confirmed between 2003 and 2015. There are significant differences in some clinicopathological characteristics and CT features between MGC and NMGC. NMGC occurs preferentially in males and more frequently in the lower third of the stomach. Patients with MGC were characterized by larger tumor size, more advanced tumor stages (II and III) and fewer lymphatic invasions. Layered enhancement (83.3%) was the main pattern of MGC, while the most common pattern in NMGC was homogeneous enhancement (52.6%), followed by heterogonous enhancement (34.6%). The degree of enhancement of the inner layer in MGC was significantly higher than in NMGC (ΔCT of portal venous phase: 54.57 Hu vs. 47.19 Hu, P = 0.034), while the middle or outer layer in MGC was significantly less enhanced (ΔCT of portal venous phase: 19.07 Hu vs. 33.09 Hu, P <0.001). Calcifications were more common in MGC (P <0.001). ROC curves revealed that the most effective variables in distinguishing MGC and NMGC were ΔCT of the middle or outer layer in the arterial phase (AUC=0.774) and portal venous phase (AUC=0.774), followed by the attenuation value of the middle or outer layer in the unenhanced phase (AUC=0.763). Calcifications had a high specificity (98.7%) in the diagnosis of MGC. The accuracy (86.1%), sensitivity (83.3%) and specificity (87.2%) of layered enhancement in diagnosing MGC were all high. Therefore, MGC was more likely to have larger tumor size and more advanced tumor stage (II and III) than NMGC. The thicker gastric wall, layered enhancement pattern and calcification were highly suggestive CT features for differentiating MGC from NMGC.

Prognosis of early mucinous gastric carcinoma

PurposeLittle is known about the clinicopathological features of early mucinous gastric carcinoma (MGC). The purpose of this study was to compare the clinicopathological features and prognosis between patients with early MGC and those with early nonmucinous gastric carcinoma (NMGC).MethodsWe reviewed the records of 2,732 patients diagnosed with gastric carcinoma who were treated surgically. There were 14 patients (0.5%) with early MGC and 958 with early NMGC.ResultsEarly MGC patients had a higher prevalence of elevated type (71.4%) compared with early NMGC patients (29.5%). More early MGC patients had submucosal carcinoma, compared with early NMGC patients (78.6% vs. 64.1%). The overall 5-year survival of the patients with early MGC was 97.2% as compared with 92.7% for the patients with early NMGC (P < 0.01). The statistically significant prognostic parameters influencing the 5-year survival rate according to Cox's proportional hazard regression model were: age (risk ratio, 2.22; 95% confidence interval [CI], 1.62-3.04; P < 0.01); sex (risk ratio, 1.97; 95% CI, 1.42-2.73; P < 0.01); and lymph node metastases (risk ratio, 1.88; 95% CI, 1.28-2.77; P < 0.01).ConclusionPatients with early MGC had a better prognosis than those with early NMGC. Mucinous histology itself appears not to be an independent prognostic factor. Therefore, early detection is important for improving the prognosis for patients with gastric carcinoma regardless of tumor histology.

Clinicopathologic features and prognosis analysis of mucinous gastric carcinoma

Mucious gastric carcinoma (MGC) is a subtype of gastric carcinoma and its clinicopathologic features and prognosis still remain unclear. To investigate the clinical significance and surgical outcomes of mucinous gastric carcinoma, 2,769 patients with gastric carcinoma were analyzed in a case control study. We reviewed the records of 196 patients with mucinous gastric carcinoma and 2,573 with nonmucinous gastric carcinoma (NGC). Clinicopathologic features and survival rate of patients were analyzed. In all registered patients, patients with MGC had a larger size, more T3 and T4 invasion to the gastric wall, more positive lymph node metastasis, more III and IV stage and more positive peritoneal dissemination, but less curative gastrectomy. In curative gastrectomy patients, MGC had larger size, deeper invasion to gastric wall, more positive lymph node metastasis and more advanced TNM stage. The overall survival rate in curative gastrectomy patients with MGC was significantly lower than that for patients with NGC (P < 0.021). Age (P = 0.001), location of tumor (P < 0.001), Borrmann type (P = 0.037), depth of invasion (P < 0.001), lymph node metastasis (P < 0.001) and lymphovascular invasion (P = 0.001) were independent prognostic factors of gastric carcinoma, but MGC itself was not. The prognosis of MGC did not have significant difference compared with NGC. Frequently, MGC was of advanced stage at the time of diagnosis. Age, location of tumor, Borrmann type, depth of invasion, lymph node metastasis and lymphovascular invasion are independent prognostic factors of gastric carcinoma, but mucinous histological type itself is not. Further study on the origin and progression of MGC is needed in future.

Clinicopathological Characteristics and Computed Tomography Features of Mucinous Gastric Carcinoma

This study investigated the clinicopathological characteristics of mucinous gastric carcinoma (MGC) and assessed whether multidetector-row computed tomography (MDCT) could differentiate MGC from non-mucinous gastric carcinoma (NGC). Clinicopathological data from 542 patients with gastric carcinoma (23 MGC, 519 NGC), who underwent pre-operative MDCT examination and curative or palliative gastrectomy, were analysed. Only seven of the 23 patients with MGC were correctly diagnosed pre-operatively by endoscopic biopsy. The MGC patients had larger tumours, a higher frequency of lymph node metastases, were more likely to have tumours of tumour, node, metastasis stages III and IV, and were less likely to have a curative resection than NGC patients. In addition, five MGC patients had calcifications in the thickened gastric wall. In conclusion, MGC is rare and is detected mostly at an advanced stage. The diagnostic sensitivity of MGC by endoscopic biopsy was relatively low, whereas MDCT was helpful in distinguishing MGC from NGC.

Mucinous Gastric Cancer Presents with More Advanced Tumor Stage and Weaker β-Catenin Expression than Nonmucinous Cancer

Mucinous gastric carcinoma (MGC) is a rare type of gastric cancer; its biological behavior is controversial. In this study, we attempted to clarify the clinical and pathological features as well as the prognostic significance of MGC. We also compared the expression patterns of CDX-2 and β-catenin between MGC and nonmucinous gastric carcinoma (NMGC). We reviewed the records of 9218 patients with gastric cancer who underwent gastric cancer surgery between January 1997 and December 2006. The clinicopathological features and clinical outcome of MGC (n=197) were compared to NMGC (n=9021). Immunohistochemical staining using the tissue array method was performed on MGC (n=194) and NMGC (n=89) tissues. MGC had a larger size and a higher frequency of Borrmann type I findings in advanced cases than NMGC. In addition, MGC had deeper invasion, more lymph node and lymphatic involvement, a more advanced tumor stage, and lower 5-year survival rates than NMGC. Age, depth of invasion, lymph node metastasis, lymphatic invasion, and curability were independent prognostic factors; but the mucinous histological type itself was not predictive of outcome. β-Catenin immunoreactivity was statistically significantly weaker in MGC than NMGC; however, there was no difference in CDX-2 expression between the two groups. MGC presents at a more advanced stage and was larger than NMGC. The poor prognosis of MGC was related to the more advanced tumor stage at diagnosis; the histological type was not an independent prognostic factor. The result of immunohistochemical staining suggests that MGC has a distinct pathway of carcinogenesis from NMGC.

Clinicopathologic characteristics and prognosis of mucinous gastric carcinoma

Reports of clinicopathological features and prognosis in patients with mucinous gastric carcinoma (MGC) are conflicting. The aim was to describe the clinicopathological features and prognosis of patients with MGC in comparison with nonmucinous gastric carcinoma (NMGC). We reviewed the records of 1,278 consecutive patients diagnosed with gastric carcinoma who were resected surgically from 1993 to 2003. Among them, 48 patients (3.8%) with MGC were compared to 1,230 patients with NMGC. There were significant differences in tumor location, stage of disease, lymphatic invasion, and vascular invasion between the patients with MGC and NMGC. The overall 5-year survival of patients with MGC was 27.2% as compared with 42.8% for patients with NMGC (P = 0.031). For the patients with the same stage, there was no significant difference between MGC and NMGC. With respect to patients with MGC, multivariate analysis showed that lymph node metastasis and curative resection were significant factors affecting survival. MGC is rare and detected mostly in an advanced stage. Mucinous histology type itself is not an independent prognostic factor.

Mucinous versus nonmucinous gastric carcinoma: differentiation with helical CT.

To assess the capability of helical computed tomography (CT) to assist in the differentiation between mucinous and nonmucinous gastric carcinomas, with a focus on the thickened stomach wall itself. In 62 patients with pathologically proved mucinous (n = 21) or nonmucinous (n = 41) gastric carcinomas, contrast material-enhanced helical CT images were obtained. The gross appearance, contrast enhancement pattern, predominant thickened layer, and degree of enhancement were retrospectively evaluated. Statistical analyses were performed with Fisher exact, chi(2), and Student t tests. A P value of less than.05 was considered to indicate a statistically significant difference. The most common type of gross appearance in both carcinomas was fungating: It occurred in 71% of patients with mucinous carcinomas and in 59% of patients with nonmucinous carcinomas. The next most common gross appearance type was ulcerative (24% of patients) in nonmucinous carcinomas and diffusely infiltrative (29% of patients) in mucinous carcinomas (P =.009). The most common contrast enhancement pattern was homogeneous (61% of patients) in nonmucinous carcinomas and layered (62% of patients) in mucinous carcinomas (P =.001). These findings were significantly different. The predominantly affected thickened layer was the high-attenuating inner layer or the entire layer (88% of patients) in nonmucinous carcinomas and the low-attenuating middle or outer layer (57% of patients) in mucinous carcinomas. Only two mucinous tumors showed miliary punctate calcifications in infiltrative lesions. Helical CT may assist in distinguishing mucinous from nonmucinous gastric carcinoma, primarily on the basis of enhancement pattern, predominant layer of the thickened wall, gross appearance, and presence of calcifications.

Clinicopathologic Features of Mucinous Gastric Carcinoma

Background/Aims: Mucinous gastric carcinoma (MGC) is a histopathologic subtype of gastric carcinoma with a poor prognosis. The purpose of this study was to compare the disease course of MGC with non-mucinous gastric carcinoma (NMGC) and study the clinicopathologic features that influence the prognosis of MGC patients. Methods: We reviewed the records of 2,383 patients with a confirmed histologic diagnosis of gastric carcinoma. There were 157 patients with MGC compared to 2,226 with NMGC. Results: A depth of invasion greater than T3 was more frequently found in MGC than in NMGC. The mean number of lymph nodes with metastases was 2.78 in MGC and 2.28 in NMGC (p < 0.001). There were more MGC patients with TNM stages II through IV (UICC classification). The overall survival rate was lower for the MGC group (46.5%) than for the NMGC group (64.0%; p < 0.05). Depth of invasion, lymph node metastases, and stage at diagnosis were significant factors affecting the outcome. Conclusion: The factors influencing the poorer prognosis (lower 5-year survival rate) of MGC are the advanced stage at the time of diagnosis, lymph node metastases, and a higher TNM status. Mucinous histologic type itself was not an independent predictive factor in survival.

Pathology and prognosis of mucinous gastric carcinoma.

Clinicopathologic characteristics of mucinous gastric carcinoma (MGC) are unclear, and whether surgical results of MGC are unfavorable is controversial. Pathology and prognosis of patients with MGC were studied using multivariate analysis. The study included 17 patients with MGC and 614 with nonmucinous gastric carcinoma (NGC). The tumor was defined as MGC when more than one half of tumor area had mucin pools. Patients were evaluated with regard to age, sex, tumor location, size, gross type, depth of wall invasion, lymph node metastasis, lymphatic and vascular permeations, stage of disease, and operative curability. MGC tumors, when compared with NGC tumors, were featured by the large size (9.0 vs. 5.2 cm), grossly infiltrative type (76 vs. 30%), T2 or more invasion (100 vs 53%), positive lymph node metastasis (88 vs. 32%), lymphatic permeation (94 vs. 55%), vascular permeation (47 vs. 25%), and stages III and IV (88 vs. 32%). On a multivariate analysis, mucinous histologic type was not an independent prognostic factor. Although 5-year survival rate for all MGC patients was lower than that for all NGC patients, the survival rate was not different between the MGC and NGC patients when compared in the same category of tumor size, depth of wall invasion, lymph node metastasis, and stage. MGC is rare and detected mostly in an advanced stage. Mucinous histologic type itself is not a prognostic significance in patients with gastric carcinoma, and the biologic behavior of MGC is similar to that of ordinary advanced gastric carcinoma.

Clinicopathologic study of early‐stage mucinous gastric carcinoma

BACKGROUND Mucinous gastric carcinoma (MGC) is rare, and whether MGC behaves more aggressively than nonmucinous gastric carcinoma (NGC) is controversial. To the authors' knowledge, there is no study of early-stage MGC, and the pathology and prognosis of patients who have early MGC is unknown. The aim of this study was to clarify the clinicopathologic characteristics of early MGC. METHODS Pathologic and prognostic data of 30 patients who had early MGC were compared retrospectively against data of 165 patients who had early NGC and 58 patients who had advanced MGC. We defined MGC as a tumor in which more than half of the tumor area contained extracellular mucin pools. We defined early gastric carcinoma as a tumor restricted to the mucosa or to the mucosa and submucosa (T1, International Union Against Cancer [UICC], 1997) regardless of lymph node metastasis. RESULTS Early MGC tumors, compared with early NGC tumors, were characterized by macroscopic elevation (57% vs. 23%, P < 0.01) and invasion to the submucosa (83% vs. 44%, P < 0.01). Tumor size, frequency of lymph node metastasis, and patient outcome did not differ between the two types, and no patient with early MGC died of recurrence during a median follow-up period of 67 months. When early MGC was compared with advanced MGC, tumor size (2.9 cm vs. 9.4 cm, P < 0.01), frequency of lymph node metastasis (10% vs. 88%,P < 0.01), total gastrectomy (0% vs. 52%, P < 0.01), noncurative surgery (0% vs. 38%, P < 0.01), and recurrent death (0% vs. 57%, P < 0.01) differed significantly. CONCLUSIONS Our results indicated that although the macroscopic features of early MGC differed from those of early NGC, patient prognosis and the frequency of lymph node metastasis did not differ. Neither did mucinous histology seem to influence outcome adversely after gastrectomy. Cancer 2001;91:698–703. © 2001 American Cancer Society.

Clinicopathologic study of early-stage mucinous gastric carcinoma

Mucinous gastric carcinoma (MGC) is rare, and whether MGC behaves more aggressively than nonmucinous gastric carcinoma (NGC) is controversial. To the authors' knowledge, there is no study of early-stage MGC, and the pathology and prognosis of patients who have early MGC is unknown. The aim of this study was to clarify the clinicopathologic characteristics of early MGC. Pathologic and prognostic data of 30 patients who had early MGC were compared retrospectively against data of 165 patients who had early NGC and 58 patients who had advanced MGC. We defined MGC as a tumor in which more than half of the tumor area contained extracellular mucin pools. We defined early gastric carcinoma as a tumor restricted to the mucosa or to the mucosa and submucosa (T1, International Union Against Cancer [UICC], 1997) regardless of lymph node metastasis. Early MGC tumors, compared with early NGC tumors, were characterized by macroscopic elevation (57% vs. 23%, P < 0.01) and invasion to the submucosa (83% vs. 44%, P < 0.01). Tumor size, frequency of lymph node metastasis, and patient outcome did not differ between the two types, and no patient with early MGC died of recurrence during a median follow-up period of 67 months. When early MGC was compared with advanced MGC, tumor size (2.9 cm vs. 9.4 cm, P < 0.01), frequency of lymph node metastasis (10% vs. 88%,P < 0.01), total gastrectomy (0% vs. 52%, P < 0.01), noncurative surgery (0% vs. 38%, P < 0.01), and recurrent death (0% vs. 57%, P < 0.01) differed significantly. Our results indicated that although the macroscopic features of early MGC differed from those of early NGC, patient prognosis and the frequency of lymph node metastasis did not differ. Neither did mucinous histology seem to influence outcome adversely after gastrectomy.

Author reply

We would like to thank Dr. Adachi et al. for their comments regarding our recently published article.1 In their interesting study,2 they chose all mucinous gastric carcinoma (MGC) cases for their study, including early gastric carcinoma. However, they excluded the only early gastric carcinoma case when comparing with MGC cases with cases of advanced nonmucinous gastric carcinoma (NGC). We misinterpreted their study significantly. Although the majority of MGCs were diagnosed at an advanced stage, we were interested in both early (18%) and advanced (82%) cases. In the univariate analysis, we observed the more aggressive biologic behavior of MGC. However, multivariate analysis disclosed the worse prognosis of MGC when correlated with more frequent serosal invasion and more advanced stage at diagnosis, not with the mucinous histologic type. The conclusion was compatible with the study of Adachi et al. regarding advanced MGC and NGC. However, our study results also could be applied to early stage MGC. We hope the article will be helpful in providing a more complete understanding of MGC. Chun-Ying Wu M.D., M.P.H.*, Hong-Zen Yeh M.D. , Rocky Tai-Ping Shih , Gran-Hum Chen M.D.?, * Section of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital; China Medical College, Taichung, Taiwan, Republic of China, Section of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China, Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China, ? Section of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China

Clinicopathologic characteristics of mucinous gastric adenocarcinoma.

There has been considerable controversy over the prognosis of mucinous gastric adenocarcinoma (MGC). In this study we analyzed the clinicopathologic differences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, the relationship between mucin content and other clinicopathologic variables, including prognosis in MGC, was also investigated. We reviewed 2118 patients with pathologically-confirmed gastric cancer who underwent gastrectomy at the Department of Surgery, Yonsei University College of Medicine, during the period between Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma with extracellular mucin (MGC) and 1988 patients had gastric carcinoma without extracellular mucin (NMGC). We placed the MGC patients into two groups according to mucin content: mucin content involving over 50% of the tumor (dominant type, n = 94) and mucin content involving less than 50% of the tumor area (partial type, n = 36). The results were as follows: MGC was more common in males than NMGC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC (mean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV (MGC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: 48.6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal metastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with MGC were more advanced in stage at the time of diagnosis and had a worse overall 10-year survival rate (44.9%) than patients with NMGC (54.7%). However, the 10-year survival rate according to the stage of MGC was similar to that of NMGC. There were no significant differences between the mucin content and other pathologic variables, including prognosis, i.e. similar biologic behavior between dominant type MGC and partial type MGC. In conclusion, we suggest that MGC was more frequently diagnosed in advanced stage than NMGC with a poorer prognosis and that it is reasonable to consider the carcinoma with mucin content involving more than 30% of the tumor area as MGC.

A clinicopathologic study of mucinous gastric carcinoma including multivariate analysis.

Mucinous gastric carcinoma (MGC) is a rare subtype of gastric adenocarcinoma, and its clinical and pathologic features are still controversial. To clarify the significance of this subtype of carcinoma, the authors conducted a case-control study to investigate the clinicopathologic characteristics of MGC and determine whether this mucin-producing histologic type is associated with a worse prognosis than other gastric carcinomas. Twenty-two cases of MGC and 46 patients with nonmucinous gastric carcinoma (NGC) were included. Patients were evaluated on the basis of age, gender, tumor size, location, depth of tumor invasion, histologic differentiation, lymph node involvement, organ metastasis, stage at presentation, surgical curability, adjuvant chemotherapy and radiation therapy. To determine whether the MGC itself was an independent prognostic factor, a multivariate analysis was performed with the Cox proportional hazards model. The MGC patients were found to have larger tumors (P < 0.001), tumors more often located in the upper stomach (P < 0.05), more serosal invasion (P < 0.05), more lymph node involvement (P < 0.05), greater frequency of advanced stage disease (P < 0.01), and lower 5-year survival rates (P < 0.05) than NGC patients. There was no significant correlation between the subtypes of differentiation of MGC and other data, including the prognosis. Multivariate analysis showed that clinically important predictive factors were serosal invasion and disease stage at diagnosis. The mucinous histologic type itself was not an independent factor for poor prognosis. The overall survival rate for patients with MGC was worse than that for patients with NGC. The poor prognosis was correlated with more advanced stage at diagnosis and more frequent serosal invasion, not with the mucinous histologic type.