Risk of lymph node metastasis and prognostic outcome in early gastric cancer patients with mixed histologic type |
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| Institution: | 1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, P.R. China;2. Department of Clinical Medicine, Dalian Medical University, Dalian, P.R. China;1. Medical Oncology Service, Virgen de la Salud Hospital, Toledo, Spain;2. Radiodiagnostic Service, Virgen de la Salud Hospital, Toledo, Spain;1. Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China;2. National Clinical Research Center for Cancer, Tianjin, China;3. Tianjin''s Clinical Research Center for Cancer, Tianjin, China;4. The Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;5. Department of General Surgery, Weifang People''s Hospital, Weifang City, Shandong Province, China;6. Department of Gastrointestinal Cancer Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China;7. Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China;1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, PR China;2. Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, PR China;1. Division of Dermatology, IRCCS Policlinico di Sant''Orsola, via Massarenti 9, 40138 Bologna, Italy;2. Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy;3. Division of Oncology, IRCCS Policlinico di Sant''Orsola, via Massarenti 9, 40138 Bologna, Italy |
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| Abstract: | BackgroundWhether early gastric cancer with mixed histologic type should be considered for endoscopic submucosal dissection (ESD) remains controversial. The objective of this study was to evaluate the risk of lymph node metastasis (LNM) and prognostic significance for early gastric cancer with mixed histologic type.MethodsWe retrospectively reviewed clinicopathologic and survival data of 302 patients who underwent surgical resection for early gastric cancer. Based on the histologic components, all patients were classified as pure differentiated type, pure undifferentiated type and mixed histologic type. The prognostic differences between different types were compared and predictive factors for LNM were evaluated.ResultsHistopathologically, the proportion of mixed histologic type was 12.3% in early gastric cancer. In terms of LNM, mixed histologic type had a more frequent incidence than pure differentiated type (32.4% vs 11.1%, P < 0.01). However, there was no significant difference between mixed type and pure undifferentiated type for LNM (32.4% vs 21.1%, P = 0.139). Multivariate analysis revealed that tumor size >2 cm (odds ratio OR]: 2.153, 95% confidence interval CI]: 1.113-4.164, P < 0.05), submucosal invasion (OR: 3.881, 95%CI: 1.832-8.222, P < 0.001), lymphovascular invasion (OR: 8.797, 95% CI: 2.643-29.277, P < 0.001), undifferentiated type (OR: 3.146, 95% CI: 1.352-7.320, P < 0.01), and mixed histologic type (OR: 3.635, 95% CI: 1.272-10.390, P < 0.05) were independent risk factors for LNM in early gastric cancer patients. However, mixed histologic type did not affect the survival outcome of these patients (hazard ratio: 0.629, 95% CI: 0.074-5.311, P > 0.05).ConclusionMixed histologic type was an independent risk factor for lymph node metastasis in early gastric cancer patients. The decisions regarding endoscopic submucosal dissection for mixed histologic type should be carefully considered. |
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