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Is the recent WHO histological classification for gastric cancer helpful for application to endoscopic resection?

 Yong Hoon Kim  ;  Jie-Hyun Kim  ;  HyunKi Kim  ;  Hoguen Kim  ;  Yong Chan Lee  ;  Sang Kil Lee  ;  Sung Kwan Shin  ;  Jun Chul Park  ;  Hyun Soo Chung  ;  Jae Jun Park  ;  Young Hoon Youn  ;  Hyojin Park  ;  Sung Hoon Noh  ;  Seung Ho Choi 
 Gastric Cancer, Vol.19(3) : 869-875, 2016 
Journal Title
 Gastric Cancer 
Issue Date
Adenocarcinoma/classification ; Adenocarcinoma/secondary* ; Adenocarcinoma/surgery ; Carcinoma, Signet Ring Cell/classification ; Carcinoma, Signet Ring Cell/secondary* ; Carcinoma, Signet Ring Cell/surgery ; Endoscopy Female ; Follow-Up Studies ; Gastric Mucosa/pathology* ; Gastroscopy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Invasiveness ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/classification ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery ; World Health Organization
Early gastric cancer ; Endoscopic resection ; Lymph node metastasis ; Undifferentiated
BACKGROUND: Endoscopic resection is performed in undifferentiated-type early gastric cancer (UD-EGC), including poorly differentiated (PD) adenocarcinoma and signet ring cell (SRC) carcinoma. We previously found that different approaches are needed for PD adenocarcinoma and SRC carcinoma for curative resection. However, according to the 2010 WHO classification, diffuse-type PD adenocarcinoma and SRC carcinoma are categorized in the "poorly cohesive carcinomas." Thus, we assessed whether the WHO classification is helpful when endoscopic resection is performed for treatment of UD-EGC. METHODS: We analyzed clinicopathological features of 1295 lesions with SRC carcinoma and PD adenocarcinoma treated by open surgery. We recategorized them into intestinal-type PD adenocarcinomas and poorly cohesive carcinomas (SRC carcinoma, diffuse-type PD adenocarcinoma). We also recategorized 176 lesions treated by endoscopic resection into intestinal-type PD adenocarcinomas and poorly cohesive carcinomas. RESULTS: According to the open surgery data, the rates of lymph node metastasis (LNM) and lymphovascular invasion were significantly lower in SRC carcinoma than in diffuse-type and intestinal-type PD adenocarcinomas. The rates of LNM and lymphovascular invasion were significantly higher in diffuse-type PD adenocarcinoma than in SRC carcinoma. Endoscopic resection data showed no recurrence if the carcinoma was curatively resected. However, the commonest cause of noncurative resection was different in SRC carcinoma and PD adenocarcinoma. A positive lateral margin was the commonest cause in SRC carcinoma versus a positive vertical margin in both intestinal-type and diffuse-type PD adenocarcinoma. CONCLUSIONS: The clinical behavior differs in diffuse-type PD adenocarcinoma and SRC carcinoma. On the basis of LNM and outcomes of endoscopic resection, the recent WHO classification may not be helpful when endoscopic resection is performed for treatment of UD-EGC.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김지현(Kim, Jie-Hyun) ORCID logo https://orcid.org/0000-0002-9198-3326
김현기(Kim, Hyunki) ORCID logo https://orcid.org/0000-0003-2292-5584
김호근(Kim, Ho Keun)
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
박재준(Park, Jae Jun)
박준철(Park, Jun Chul) ORCID logo https://orcid.org/0000-0001-8018-0010
박효진(Park, Hyo Jin) ORCID logo https://orcid.org/0000-0003-4814-8330
신성관(Shin, Sung Kwan)
윤영훈(Youn, Young Hoon) ORCID logo https://orcid.org/0000-0002-0071-229X
이상길(Lee, Sang Kil) ORCID logo https://orcid.org/0000-0002-0721-0364
이용찬(Lee, Yong Chan)
정현수(Chung, Hyun Soo)
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
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