Effect of World Health Organization (WHO) Histological Classification on Predicting Lymph Node Metastasis and Recurrence in Early Gastric Cancer

Abstract

BackgroundThe World Health Organization (WHO) histological classification for gastric cancer is widely accepted and used. However, its impact on predicting lymph node metastasis and recurrence in early gastric cancer (EGC) is not well studied.Material/MethodsFrom 1987 to 2005, 2873 EGC patients with known WHO histological type who had undergone curative resection were enrolled in this study. In all, 637 well-differentiated adenocarcinomas (WD), 802 moderately-differentiated adenocarcinomas (MD), 689 poorly-differentiated adenocarcinomas (PD), and 745 signet-ring cell adenocarcinomas (SRC) were identified.ResultsThe distribution of demographic and clinical features in early gastric cancer among WD, MD, PD, and SRC were significantly different. Lymph node metastasis was observed in 317 patients (11.0%), with the lymph node metastasis rate being 5.3%, 14.8%, 17.0%, and 6.3% in WD, MD, PD, and SRC, respectively. Univariate and multivariate analyses indicated that gender, tumor size, gross appearance, depth of invasion, and WHO classification were significantly associated with lymph node metastasis. Recurrence was observed in 83 patients (2.9%), with the recurrence rate being 2.2%, 4.5%, 3.0%, and 1.6% in WD, MD, PD, and SRC, respectively. Multivariate analysis confirmed that MD, elevated gross type, and lymph node metastasis were independent risk factors for recurrence in EGC. MD patients showed worse disease-free survival than non-MD patients (P=0.001).ConclusionsWHO classification is useful and necessary to evaluate during the perioperative management of EGC. Treatment strategies for EGC should be made prudently according to WHO classification, especially for MD patients.

Risk factors of lymph node metastasis in 734 early gastric carcinoma radical resections in a Chinese population

“…In this study, the overall risk of LNM was greatly increased from 5.5% (19/343) in patients with intramucosal EGC to 21.7% (85/391) in those with submucosal EGC. The results were parallel to those reported previously . There was no LNM in the 142 intramucosal EGC cases of <2.0 cm in size without poor differentiation.…”

“…Overall, the prevalence of LNM in patients with EGC of this cohort was 14.2%, which was similar to that reported in other centers in China, the United States, Brazil, France and Germany, but not in Japan and Korea in which significantly lower frequency of LNM were observed. In this study we found five independent risk factors of LNM in EGC, including a tumor size of ≥3.0 cm, deep submucosal invasion (SM2), moderate/poor tumor differentiation, LVI and tumor necrosis.…”

Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer

“…In previous studies, depth of infiltration was also considered to be extremely relevant to LNM. 8,20,23,28,29 Some studies reported that, although the mucosa showed an enrichment of blood capillaries, lymphatic ducts were only abundant in the deeper lamina propria and submucosa. 30,31 This may explain the relationship between LNM and depth of invasion.…”

“…Moreover, a series of studies stated that female sex was significantly associated with the presence of LNM in EGC patients. 25,29,41,42 The relationship between sex and LNM in EGC needs further investigation.…”

Differences in the Microsurface and Microvascular Features between Early Gastric Cancer of Corpus and Antrum under Narrow Band Imaging Magnifying Endoscopy

“…The histologic diagnosis of EGC was according to WHO classi cation [22]. The WHO classi cation is commonly divided into 2 major categories in clinical study: differentiated and undifferentiated type (Nakamura's classi cation) [23,24]. The former includes well-differentiated adenocarcinoma, moderately-differentiated adenocarcinoma, and papillary adenocarcinoma, and the latter includes poorly-differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma.…”