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Early gastric cancer of signet ring cell carcinoma is more amenable to endoscopic treatment than is early gastric cancer of poorly differentiated tubular adenocarcinoma in select tumor conditions

Authors
 Hee Man Kim  ;  Kyung Ho Pak  ;  Moon Jae Chung  ;  Jae Hee Cho  ;  Woo Jin Hyung  ;  Sung Hoon Noh  ;  Choong Bai Kim  ;  Yong Chan Lee  ;  Si Young Song  ;  Sang Kil Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.25(9) : 3087-3093, 2011 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2011
MeSH
Adenocarcinoma/pathology ; Adenocarcinoma/secondary ; Adenocarcinoma/surgery* ; Aged ; Carcinoma, Signet Ring Cell/pathology ; Carcinoma, Signet Ring Cell/secondary ; Carcinoma, Signet Ring Cell/surgery* ; Cell Differentiation ; Female ; Gastroscopy* ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Stomach Ulcer/pathology ; Treatment Outcome
Keywords
Early gastric cancer ; Endoscopic submucosal dissection ; Lymph node metastasis ; Risk factor
Abstract
BACKGROUND: Recently, endoscopic submucosal dissection has been carefully applied in early gastric cancer (EGC) with undifferentiated type. However, there are no individual guidelines for endoscopic treatment of EGCs with poorly differentiated tubular adenocarcinoma or signet ring cell carcinoma. The aim of this study was to investigate and compare the clinicopathologic features of these two types of EGC to guide the application of endoscopic treatment.

METHODS: Patients to undergo radical gastrectomy for the treatment of EGC were selected for inclusion in this study. Histology was classified according to the Japanese Gastric Cancer Association. Between January 2005 and December 2008, 288 patients with poorly differentiated EGC and 419 patients with signet ring cell EGC were enrolled. Their medical records were reviewed retrospectively.

RESULTS: Compared with signet ring cell EGC, poorly differentiated EGC had higher rates of male gender, old age (≥45 years), large tumor length (>20 mm), ulcer, submucosal invasion, lymphovascular invasion, and lymph node metastasis. In the multivariate analyses, poorly differentiated EGC was significantly associated with ulcer (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.5-3.8), submucosal invasion (OR: 3.6, 95% CI: 2.6-5.1) and lymphovascular invasion (OR: 2.0, 95% CI: 1.1-3.6) with a reference of signet ring cell EGC. The independent risk factors for lymph node metastasis were large tumor length, submucosal invasion, and lymphovascular invasion in both types of EGC. Young age was an independent risk factor of lymph node metastasis only in poorly differentiated EGC.

CONCLUSIONS: Poorly differentiated EGC has clinicopathologic features that are less favorable to endoscopic treatment than are those of signet ring cell EGC. Therefore, these two types of EGC should be approached separately, not as a united type of undifferentiated histology, during the planning of endoscopic treatment
Full Text
http://link.springer.com/article/10.1007%2Fs00464-011-1674-5
DOI
10.1007/s00464-011-1674-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Choong Bai(김충배)
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Pak, Kyung Ho(박경호)
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
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
Chung, Moon Jae(정문재) ORCID logo https://orcid.org/0000-0002-5920-8549
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94234
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