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. (March 2017)

• Record Type: Journal Article
• Authors: Lee, In Seob; Lee, Sol; Park, Young Soo; Gong, Chung Sik; Yook, Jeong Hwan; Kim, Byung Sik
• Is Part Of: Surgical oncology. Volume 26:Number 1(2017)
• Page Start: 8
• Page End: 12
• Publication Date: 2017-03
• Subjects: Undifferentiated gastric cancer -- Lymph node metastasis -- Mixed histology; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2016.12.001
• Languages: English
• ISSNs: 0960-7404

Abstract

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. Highlights: Mixture of poorly differentiated adenocarcinoma and signet ring cell carcinoma is a predictive factor of nodal metastasis. Mixed type tumors should not be considered for endoscopic resection. No nodal metastasis was seen in T1a tumors with poorly differentiated adenocarcinoma < 2 cm without lymphovascular invasion. No nodal metastasis was seen in T1a tumors with signet ring cell carcinoma < 1 cm without lymphovascular invasion.