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Gastric Cancer

, Volume 21, Issue 4, pp 661–671 | Cite as

Establishment of pathological quantitative method for determining undifferentiated component ratio in patients with differentiated/undifferentiated mixed-type early gastric cancer and clinical significance of this ratio

  • Hirohisa Takeuchi
  • Nobutsugu Abe
  • Yoshikazu Hashimoto
  • Atsuko Ooki
  • Gen Nagao
  • Kazuhiko Hirano
  • Yasuo Ookura
  • Tadahiko Masaki
  • Toshiyuki Mori
  • Masanori Sugiyama
Original Article
  • 116 Downloads

Abstract

Purposes

The purpose of this study was to establish a pathological quantitative method for determining the undifferentiated components ratio (UCR) in patients with differentiated/undifferentiated mixed-type (Mixed-type) early gastric cancer (EGC) and to examine the clinical significance.

Methods

The subjects were 410 patients who underwent surgical resection for EGC with the invasion limited to m or sm1. Analysis 1: In 12 randomly selected patients with Mixed-type cancer, we calculated the area ratio and the ratio of the length ratio using ImageJ and analyzed the correlation between them. Analysis 2: We generated ROC curves, and determined the cutoff UCR on the basis of the predictive risk factors for lymph node metastasis (LNM). Analysis 3: We analyzed the relationship between clinicopathological factors including UCR/length of undifferentiated component (LUC = maximum dimensions of tumor × UCR) and LNM.

Results

Analysis 1: The length ratio can be used as a substitute parameter for the UCR (r = 0.996). Analysis 2: The cutoff UCR as a risk factor for LNM was 58% (sensitivity = 1, 1 − specificity = 0.404). Analysis 3: Lymphovascular invasion (p < 0.0001), UCR ≥58% (p = 0.023), and LUC ≥25 mm (p = 0.005) were identified as significant risk factors for LNM. No LNM was observed in patients with invasion limited to m or sm1 and negativity for lymphovascular invasion and UCR <58% (0/215).

Conclusions

In the patients with Mixed-type EGC, the length ratio of undifferentiated components can be a substitute parameter for the UCR. LNM rarely occurs in patients without lymphovascular invasion and with an UCR <58%. The analysis of the UCR has great significance in determining whether additional surgical resection is required after endoscopic resection.

Keywords

Early gastric cancer Mixed-type Pathological quantitative method 

Notes

Acknowledgements

We sincerely thank Professor Koji Teruya of the Faculty of Health Sciences, Kyorin University, for his advice and cooperation with the statistical processing in this study. This study acknowledge the financial support of Setsuro Fujii Memorial The Osaka Foundation for Promotion of Fundamental Medical Research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

References

  1. 1.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 14th ed. Tokyo: Kanehara; 2010 (in Japanese).Google Scholar
  2. 2.
    Egashira Y, Akutagawa H, Umegaki E, Higuchi K, Hirose Y. The clinicopathologic feature of early gastric cancer of differentiated and undifferentiated mixed type. Stomach Intest. 2013;48:1553–65 (in Japanese).Google Scholar
  3. 3.
    Tanabe H, Iwashita A, Haraoka S, Ikeda k, Oshige K, Ota A, et al. Clinicopathological characteristics of differentiated mixed-type early gastric carcinoma with lymph node metastasis. Stomach Intest. 2007;42:1561–76 (in Japanese).Google Scholar
  4. 4.
    Watanabe G, Ajioka Y, Kato T, Nishikura K. Pathological characteristics of differentiated-type early gastric carcinoma mixed with undifferentiated-type: status of lymph node metastasis and macroscopic features. Stomach Intest. 2007;42:1577–87 (in Japanese).Google Scholar
  5. 5.
    Matsuda A, Nishimata Y, Niihara T, Niou T, Shimaoka S, Torimaru H, et al. Clinical features and issues of early gastric cancer that consist of elements of well and poorly differentiated adenocarcinoma—mainly by conventional endoscopy. Stomach Intest. 2007;42:1615–24 (in Japanese).Google Scholar
  6. 6.
    Takizawa K, Ono H, Hasuike N, Tanaka M, Kusumoto k, Kadooka M, et al. Treatment for early gastric cancer of differentiated and undifferentiated mixed type. Stomach Intest. 2007;42:1647–58 (in Japanese).Google Scholar
  7. 7.
    Takizawa K, Kawada N, Tanaka M, Kakushima N, Imai K, Matsubayashi H, et al. Treatment for intramucosal gastric cancer with mixed type histology (differentiated and undifferentiated). Stomach Intest. 2013;48:1567–79 (in Japanese).Google Scholar
  8. 8.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Shimoda T, Nakanishi Y, Saito A. The histological diagnostic pitfall of early gastric cancer. Stomach Intest. 2000;35:37–45 (in Japanese).Google Scholar
  10. 10.
    Fujisaki J, Yamamoto Y, Yamamoto N, Kato Y, Tatewaki M, Tsuchida T, et al. ESD treatment for histologically mixed-type early gastric cancer (including recurrence and metastasis to the lymph node). Stomach Intest. 2007;42:1659–69 (in Japanese).Google Scholar
  11. 11.
    Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines. 3rd ed. Tokyo: Kanehara; 2010 (in Japanese).Google Scholar
  12. 12.
    Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods. 2012;9:671–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Rasband WS. ImageJ, U.S. National Institutes of Health, Bethesda, Maryland, USA. http://imagej.nih.gov/ij/. 1997–2016.
  14. 14.
    Abe N, Watanabe T, Suzuki K, Machida H, Toda H, Nakaya Y, et al. Risk factors predictive of lymph node metastasis in depressed early gastric cancer. Am J Surg. 2002;183:168–72.CrossRefPubMedGoogle Scholar
  15. 15.
    Abe N, Sugiyama M, Masaki T, Ueki H, Yanagida O, Mori T, et al. Predictive factors for lymph node metastasis of differentiated submucosally invasive gastric cancer. Gastrointest Endosc. 2004;60:242–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Okabayashi T, Kobayashi M, Sugimoto T, Okamoto K, Hokimoto N, Araki K, et al. Clinicopathological investigation of early gastric carcinoma; is less invasive surgery right for early gastric carcinoma? Hepatogastroenterology. 2007;54:609–12.PubMedGoogle Scholar
  17. 17.
    Zheng W, Li M, Xing-Mao Z, Zhi-Xiang Z, et al. Risk of lymph node metastasis from early gastric cancer in relation to depth of invasion: experience in a single institution. Asian Pac J Cancer Prev. 2014;15:5371–5.CrossRefGoogle Scholar
  18. 18.
    Youden WJ. Index for rating diagnostic tests. Cancer (Phila). 1950;3:32–5.CrossRefGoogle Scholar
  19. 19.
    Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated–type early gastric cancer. Gastric Cancer. 2009;12:148–52.CrossRefPubMedGoogle Scholar
  20. 20.
    Takizawa K, Takashima A, Kimura A, Mizusawa J, Hasuike N, Ono H, et al. A phase II clinical trial of endoscopic submucosal dissection for early gastric cancer of undifferentiated type: Japan Clinical Oncology Group study JCOG1009/1010. Jpn J Clin Oncol. 2013;43:87–91.CrossRefPubMedGoogle Scholar
  21. 21.
    An JY, Baik YH, Choi MG, Noh JH, Sohn TS, Kim S. Predictive factors for lymph node metastasis in early gastric cancer with submucosal invasion: analysis of a single institutional experience. Ann Surg. 2007;246:749–53.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017

Authors and Affiliations

  • Hirohisa Takeuchi
    • 1
  • Nobutsugu Abe
    • 1
  • Yoshikazu Hashimoto
    • 1
  • Atsuko Ooki
    • 1
  • Gen Nagao
    • 1
  • Kazuhiko Hirano
    • 2
  • Yasuo Ookura
    • 2
  • Tadahiko Masaki
    • 1
  • Toshiyuki Mori
    • 1
  • Masanori Sugiyama
    • 1
  1. 1.Department of SurgeryKyorin University School of MedicineMitakaJapan
  2. 2.Department of PathologyKyorin University School of MedicineMitakaJapan

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