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Poorly Differentiated Carcinoma Component in Submucosal Layer Should be Considered as an Additional Criterion for Curative Endoscopic Resection of Early Gastric Cancer

 Da Hyun Jung  ;  Yoon Sung Bae  ;  Sun Och Yoon  ;  Yong Chan Lee  ;  Hoguen Kim  ;  Sung Hoon Noh  ;  Hyojin Park  ;  Seung Ho Choi  ;  Jie-Hyun Kim  ;  Hyunki Kim 
 ANNALS OF SURGICAL ONCOLOGY, Vol.22(Suppl 3) : S772-S777, 2015 
Journal Title
Issue Date
Adenocarcinoma/pathology* ; Adenocarcinoma/surgery ; Cell Differentiation* ; Female ; Follow-Up Studies ; Gastrectomy* ; Gastric Mucosa/pathology* ; Gastric Mucosa/surgery ; Gastroscopy* ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery
Gastric Cancer ; Lymph Node Metastasis ; Early Gastric Cancer ; Endoscopic Resection ; Perineural Invasion
BACKGROUND: Some studies have reported lymph node metastasis (LNM) in early gastric cancer (EGC) cases meeting the expanded criteria for endoscopic resection. Therefore, we investigated whether a minor poorly differentiated carcinoma (PDC) component in the submucosal (SM) layer affects LNM in differentiated EGC. METHODS: We performed surgery in 1096 patients with differentiated SM gastric cancer and compared the clinicopathologic features of node-positive (n = 194) and node-negative (n = 902) differentiated SM cancer, with special reference to the portion of PDC component in the SM layer. RESULTS: When we categorized patients by the proportion of PDC component in the SM layer, we found 840 patients had <5 % and 256 patients had ≥5 % PDC components in the SM layer. The ≥5 % group was significantly associated with younger age, female sex, moderate differentiation, deep SM invasion, lymphovascular invasion (LVI), perineural invasion, and LNM. In multivariate analysis, middle third location, moderate differentiation, SM2 invasion, size >2 cm, LVI, and PDC components in the SM layer were independent risk factors for LNM. When we limited the depth of invasion to SM1, the incidence of LNM was significantly higher in the ≥5 % group. On multivariate analysis, tumor size >2 cm, moderate differentiation, LVI positivity, and ≥5 % PDC components in the SM1 layer were independent risk factors for LNM in SM1 cancer. CONCLUSIONS: The PDC component in the SM layer of differentiated EGC was an independent risk factor of LNM, which might constitute a supplementary criterion in the expanded indications for endoscopic resection in differentiated 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
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Kim, Hyunki(김현기) ORCID logo https://orcid.org/0000-0003-2292-5584
Kim, Ho Keun(김호근)
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Bae, Yoon Sung(배윤성)
Yoon, Sun Och(윤선옥) ORCID logo https://orcid.org/0000-0002-5115-1402
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Jung, Da Hyun(정다현)
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0002-9872-3594
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