In Seob Lee1, Sol Lee2, Young Soo Park3, Chung Sik Gong1, Jeong Hwan Yook1, Byung Sik Kim4. 1. Department of Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, 05505, South Korea. 2. Department of Surgery, Seoul Medical Center, Seoul, 02053, South Korea. 3. Department of Pathology, Ulsan University College of Medicine, Asan Medical Center, Seoul, 05505, South Korea. 4. Department of Surgery, Ulsan University College of Medicine, Asan Medical Center, Seoul, 05505, South Korea. Electronic address: bskim@amc.seoul.kr.
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) is not considered an appropriate treatment for undifferentiated early gastric cancer (UEGC) due to the higher risk of nodal metastases. We aimed to investigate predictive factors for nodal metastases in UEGCs, determine whether the tumor histology is an independent factor for it, and explore whether ESD is applicable for UEGC. METHODS: We reviewed the medical records of 1837 patients who underwent curative gastrectomy for poorly differentiated adenocarcinoma, signet ring cell carcinoma, and a mixed type of both tumors between 2008 and 2012. RESULTS: Nodal metastases were found in 208 (11.3%) patients. Multivariate analysis revealed that lymphovascular invasion and tumor histology were significantly associated with nodal metastases in mucosal cancers, the rates of which were higher in mixed type tumors (6.3%) than in the other two types (2.0-2.5%; p = 0.005). No nodal metastases were observed in poorly differentiated adenocarcinomas <2 cm and signet ring cell carcinomas <1 cm without lymphovascular invasion and confined to the mucosa. CONCLUSION: Mixed type tumors should not be considered for endoscopic resection. ESD might be applicable for mucosal tumors with poorly differentiated adenocarcinoma <2 cm and signet ring cell carcinoma <1 cm without lymphovascular invasion.
BACKGROUND: Endoscopic submucosal dissection (ESD) is not considered an appropriate treatment for undifferentiated early gastric cancer (UEGC) due to the higher risk of nodal metastases. We aimed to investigate predictive factors for nodal metastases in UEGCs, determine whether the tumor histology is an independent factor for it, and explore whether ESD is applicable for UEGC. METHODS: We reviewed the medical records of 1837 patients who underwent curative gastrectomy for poorly differentiated adenocarcinoma, signet ring cell carcinoma, and a mixed type of both tumors between 2008 and 2012. RESULTS:Nodal metastases were found in 208 (11.3%) patients. Multivariate analysis revealed that lymphovascular invasion and tumor histology were significantly associated with nodal metastases in mucosal cancers, the rates of which were higher in mixed type tumors (6.3%) than in the other two types (2.0-2.5%; p = 0.005). No nodal metastases were observed in poorly differentiated adenocarcinomas <2 cm and signet ring cell carcinomas <1 cm without lymphovascular invasion and confined to the mucosa. CONCLUSION: Mixed type tumors should not be considered for endoscopic resection. ESD might be applicable for mucosal tumors with poorly differentiated adenocarcinoma <2 cm and signet ring cell carcinoma <1 cm without lymphovascular invasion.