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Early gastric cancer with mixed histology predominantly of differentiated type is a distinct subtype with different therapeutic outcomes of endoscopic resection

Authors
 Choong Nam Shim  ;  Hyunsoo Chung  ;  Jun Chul Park  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 Surgical Endoscopy , Vol.29(7) : 1787-1294, 2015 
Journal Title
 Surgical Endoscopy  
ISSN
 0930-2794 
Issue Date
2015
Abstract
BACKGROUND: Safety of endoscopic resection (ER) for early gastric cancers (EGC) with mixed histology predominantly of differentiated type has not been securely established, since those lesions tend to exhibit lymph node metastasis, compared to pure differentiated type. The purpose of this study was to evaluate clinicopathologic characteristics, therapeutic outcomes, and risk for lymph node metastasis in predominantly differentiated mixed EGC treated by ER. METHODS: A total of 1,016 patients with 1,039 EGCs underwent ER between January 2007 and June 2013. Enrolled lesions were divided into groups of either pure differentiated (n = 1,011) or predominantly differentiated mixed (n = 28), according to the presence of mixed histology predominantly of differentiated type in ER specimen. RESULTS: Mixed histology predominantly of differentiated type was diagnosed in 2.7% of lesions. Larger size, mid-third location, and moderately differentiated histology on forceps biopsy were independent risk factors for the predominantly differentiated mixed histologic type of EGC in multivariate analysis. En bloc resection rate tended to be lower, and complete and curative resection rates were significantly lower in the predominantly differentiated mixed group. The rate of lymph node metastasis in the lesions with additional operation tended to be higher, in this mixed histology group. CONCLUSIONS: Larger size, mid-third location, and moderately differentiated histology on forceps biopsy carry the significant risk for mixed histology predominantly of differentiated type. EGC with predominantly differentiated mixed histologic type affects therapeutic outcomes and consequent clinical course accompanied by possibly higher risk for lymph node metastasis. The safety of ER for predominantly differentiated mixed EGC should be validated by further prospective investigation.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-014-3861-7
DOI
10.1007/s00464-014-3861-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Shim, Choong Nam(심충남)
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140386
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