Mixed poorly differentiated adenocarcinoma in undifferentiated-type early gastric cancer predicts endoscopic noncurative resection
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Comparisons between surgical cases of mixed poorly differentiated adenocarcinoma and pure signet ring cell carcinoma have revealed higher frequencies of lymph node metastasis and submucosal invasion in the former. However, this comparison has not been reported for endoscopically treated cases. Therefore, we compared cases of curative and noncurative resection in patients who underwent endoscopic submucosal dissection to determine what factors could influence the curative resection rate.
We analyzed 268 undifferentiated-type early gastric cancers in 264 patients treated with endoscopic submucosal dissection in our hospital between March 2005 and March 2017, involving 229 and 39 cases of curative and noncurative resection, respectively. Treatment results were compared between 129 lesions of pure signet ring cell carcinoma and 139 lesions of mixed poorly differentiated adenocarcinoma.
The overall curative resection rate was 85.4% (229/268). On comparing noncurative and curative resection cases, after excluding factors that determine curative resection (e.g., tumor diameter), we found that the former was associated with older age and significantly more mixed poorly differentiated adenocarcinomas, with odds ratios of 1.052 [95% confidence interval (CI), 1.017–1.089] and 2.746 (95% CI, 1.162–6.485), respectively, on multivariate analysis. The curative resection rate was significantly higher in pure signet ring cell carcinoma than in mixed poorly differentiated adenocarcinoma (93.8% vs. 77.7%, respectively).
Advanced age and mixed poorly differentiated adenocarcinoma predicted endoscopic noncurative resection.
KeywordsEndoscopic resection Gastric cancer Poorly differentiated adenocarcinoma Signet ring cell carcinoma
Compliance with ethical standards
Conflict of interest
There is no conflict of interest in this study.
Human rights statement and informed consent
This study was conducted in compliance with the principle of the “Declaration of Helsinki” issued in 1964 and revised thereafter. Before registration, all personal identifiers were deleted, and informed consent was obtained from all patients to allow the use of pathological specimens and imaging data for this study. The study has been approved by the institutional review board at the Cancer Institute Hospital (IRB no.2017-1033).
- 3.Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines, ver. 4. Gastric Cancer. 2014;2017(20):1–19.Google Scholar
- 4.Takizawa K, Shimoda T, Nakanishi Y, Taniguchi H, Oda I, Gotoda T. Expanded indication for endoscopic resection from pathological viewpoint: the possibility of sm invasion by undifferentiated-type early gastric cancer. Stomach Intest. 2006;41:9–17 (in Japanese).Google Scholar
- 5.Lee IS, Lee S, Park YS, Gong CS, Yook JH, Kim BS. Applicability of endoscopic submucosal dissection for undifferentiated early gastric cancer: mixed histology of poorly differentiated adenocarcinoma and signet ring cell carcinoma is a worse predictive factor of nodal metastasis. Surg Oncol. 2017;26:8–12.CrossRefPubMedGoogle Scholar
- 11.Yamamoto Y, Fujisaki J, Hirasawa T, Ishiyama A, Yoshimoto K, Ueki N, et al. Therapeutic outcomes of endoscopic submucosal dissection of undifferentiated-type intramucosal gastric cancer without ulceration and preoperatively diagnosed as 20 millimetres or less in diameter. Dig Endosc. 2010;22:112–8.CrossRefPubMedGoogle Scholar
- 17.Fried L, Barron J. Older adults. In: Handbook of urban health: population, methods, and practice. Springer: New York; 2005Google Scholar
- 24.Nakamura K, Sugano H. Microcarcinoma of the stomach measuring less than 5 mm in the largest diameter and its histogenesis. Prog Clin Biol Res. 1983;132:107–16.Google Scholar