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

Kim, Beom Su; Lee, Sol; Park, Young Soo; Gong, Chung Sik; Yook, Jeong Hwan; Kim, Byung Sik

doi:10.1016/j.suronc.2016.12.001

Cited by 35 publications

(40 citation statements)

References 22 publications

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“…A few studies have reported the LNM rate of early SRC ranges from 5 to 13.9%. Hu et al reported a higher LNM rate of both the Poorly-D type and the MP-S type than SRC, although there was no statistical difference [17,[26][27][28][29]. Our study gave results consistent with this, showing that the LNM rate of SRC is 11.3%, lower than that of the MP-S type (21.9%) and the Poorly-D type (22.7%).…”

Section: Discussionsupporting

confidence: 87%

“…In the presence of an undifferentiated component, the treatment of mixed gastric cancer needs to be cautious, while the guideline is still incomplete and controversial. Some studies have suggested that endoscopists need to judge the indications more careful when using ESD to treat mixed gastric cancer considering the low curative resection rate and high incidence of local recurrence of it [14][15][16][17][18]. However, Min et al reported that ESD can be an effective therapy for differentiated-predominantly mixed gastric cancer that meets the absolute or expanded criteria [19].…”

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confidence: 99%

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Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital

et al. 2020

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Objective The purpose of this study was to explore the role of different undifferentiated components in the lymph node metastasis (LNM) of early mixed gastric cancer. Methods A total of 1596 patients with EGC who underwent gastrectomy were divided into four types: pure differentiated (PD), pure poorly differentiated (Poorly D), pure signet ring cell carcinoma (SRC), and mixed. Mixed type was classified into four subtypes: differentiated-predominant type mixed with poorly differentiated component (MD-P), poorly differentiatedpredominant type mixed with differentiated component (MP-D), differentiated-predominant type mixed with SRC component (MD-S), and poorly differentiated-predominant type mixed with SRC component (MP-S). We analyzed the clinicopathological differences between all types and the rates of LNM of patients fulfilling endoscopic submucosal dissection (ESD) criteria. Results LNM was more common in mixed (21.9%) than in PD (7.5%, P < 0.001) or SRC (11.3%, P < 0.001). When analyzed the subgroups of mixed type, LNM was more frequent in MD-P (15.4%) than in PD (7.5%, P = 0.003). LNM in MD-S (7.4%, P = 1.000) was not higher than in PD. MP-S (24.5%) showed a higher rate of LNM than SRC (11.3%, P < 0.001) rather than Poorly-D (22.7%, P = 0.681). For lesions satisfying ESD criteria, MD-S (0%, P = 1.000), and MD-P (5.9%, P = 0.12) did not have higher rates of LNM than PD (1.4%). Conclusion The presence of poorly differentiated component but not SRC increases the LNM rate of mixed type. ESD is recommended for the treatment of MD-S and MD-P consistent with ESD criteria. Keywords Gastric cancer · Lymph node metastasis · Signet ring cell carcinomaPublisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital

et al. 2020

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“…This important finding was confirmed in this multicenter study as an independent risk factor for LNM. Thus, endoscopic therapy, such as ESD, may not be indicated for this uncommon type of EGC . This finding requires pathologists to identify and report poorly cohesive carcinoma, typically in a small proportion and admixed with well or moderately differentiated EGC.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, endoscopic therapy, such as ESD, may not be indicated for this uncommon type of EGC. 32 This finding requires pathologists to identify and report poorly cohesive carcinoma, typically in a small proportion and admixed with well or moderately differentiated EGC. Because of LNM in station 7 and station 8a in this mixed EGC, lymphadenectomy may need to be extended to station 7 and station 8a.…”

Section: In 2000mentioning

confidence: 99%

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

Chen

Wang

Cheng³

et al. 2017

J of Digest Diseases

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“…Kim et al also compared the clinicopathological characteristics of early gastric SRCC with those of the poorly differentiated EGC and found that large (>2 cm) undifferentiated EGC with ulceration, submucosal invasion and LVI in older (≥45 years) men were associated with a high incidence of LNM . All these findings show that more EGC of SRCC than undifferentiated carcinomas can be resected endoscopically . However, the risk of LNM should be comprehensively assessed as to whether additional surgery is needed for SRCC.…”

Section: Endoscopic Resection Indications For Egcmentioning

confidence: 99%

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

Zhang

Gao

et al. 2019

J of Digest Diseases

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With the wide application of endoscopic resection for early gastric cancer (EGC) by not only Asian endoscopists but also those from Western countries, reviews on standardized treatment processes before and after endoscopic resection are nevertheless lacking. In this article we provide a narrative review of studies on the selection of appropriate EGC for endoscopic resection and the follow-up strategies for those with histologically confirmed EGC after endoscopic resection. EGC should be comprehensively assessed before endoscopic resection, including its exact margin, invasive depth and risk of lymph node metastasis (LNM). While the curative resection status of EGC may be evaluated after endoscopic resection based on the newly developed eCura system, although this needs to be further verified. Surveillance with endoscopy and computed tomography scan is necessary for patients with an EGC level A or B. An additional endoscopic resection is recommended for patients with a level-C1 EGC. For patients with a level-C2 EGC, close follow-up is suggested for low-risk tumors of level C2 and additional surgery for those at high risks. Further postoperative strategy is suggested based on comprehensive assessment of the risk of LNM, patient's quality of life and wishes. K E Y W O R D Scurative resection, early gastric cancer, eCura system, endoscopy, gastric neoplasms, surveillance

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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

Cited by 35 publications

References 22 publications

Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital

Poorly differentiated is more significant than signet ring cell component for lymph node metastasis in mixed-type early gastric cancer: a retrospective study from a large-volume hospital

Risk factors of lymph node metastasis in 1620 early gastric carcinoma radical resections in Jiangsu Province in China: A multicenter clinicopathological study

Endoscopic management of patients with early gastric cancer before and after endoscopic resection: A review

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