Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Hirasawa, Toshiaki; Gotoda, Takuji; Miyata, Satoshi; Kato, You; Shimoda, Tadakazu; Taniguchi, Hirokazu; Fujisaki, Junko; Sano, Takeshi; Yamaguchi, Toshiharu

doi:10.1007/s10120-009-0515-x

Cited by 443 publications

(317 citation statements)

References 36 publications

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“…The probability of lymph node metastasis ranges from 10.2 to 22.9% in cases of SM-GC [25][26][27][28][29]. As we reported previously [30], when examining SM-GCs, it is important to take into account the histologic type of the deepest invasive portion in addition to the main histologic type.…”

Section: Discussionmentioning

confidence: 93%

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

et al. 2011

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Background The 2010 Japanese Gastric Cancer Association guidelines for the treatment of submucosal invasive gastric cancer (SM-GC) specify size 30 mm or less, differentiated-dominant histology, lack of vessel involvement, and submucosal invasion of less than 500 lm (SM1) as expanded criteria for curative endoscopic resection. Our purpose in this study was to confirm the validity of the expanded indications for curative endoscopic submucosal dissection (ESD) of SM-GC. Methods The study subjects were 173 patients with SM-GC resected by ESD at Hiroshima University Hospital between April 2002 and September 2010, including 99 patients for whom 3-plus years' follow-up information was available. Post-ESD outcomes were compared between cases of SM1-GC that met the expanded ESD criteria, those that did not, and SM2-GC cases.Results Complete resection was achieved for 93.2% of the SM1-GCs that met the expanded criteria. There was neither metastasis to lymph nodes or other organs nor local recurrence among the SM1-GCs. Disease-specific survival did not differ significantly between patients that were simply followed up after ESD and those that were treated by additional surgical resection. Conclusions Our outcome data support the clinical validity of ESD without additional surgical resection for SM1-GCs that meet the expanded criteria.

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Section: Discussionmentioning

confidence: 93%

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

et al. 2011

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“…The expanded version of the guidelines included the following criteria: i) differentiated mucosal cancer without ulceration and tumor >2 cm in size; ii) differentiated mucosal cancer with ulceration and a tumor <3 cm in size; or iii) differentiated submucosal cancer with a tumor <3 cm in size and a submucosal invasion depth of <500 µm (3). Based on a study by Hirasawa et al (4), the guidelines for ESD were further expanded and it is now accepted that carcinoma of the undifferentiated type, without ulceration and with a tumor size of <2 cm in size is included in the Japanese Gastric Cancer Treatment Guidelines 2010 (ver. 3) (4,5).…”

Section: Introductionmentioning

confidence: 99%

“…Based on a study by Hirasawa et al (4), the guidelines for ESD were further expanded and it is now accepted that carcinoma of the undifferentiated type, without ulceration and with a tumor size of <2 cm in size is included in the Japanese Gastric Cancer Treatment Guidelines 2010 (ver. 3) (4,5).…”

Section: Introductionmentioning

confidence: 99%

Significance of MUC1 expression in biopsy specimens of submucosal invasive gastric carcinoma: The association with lymph node metastasis

et al. 2015

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Abstract. Mucin 1, cell surface associated (MUC1) is a tumor-associated glycoprotein that has been reported to have an important role in lymphatic invasion and metastasis. The present study aimed to investigate the significance of MUC1 expression in endoscopic biopsy specimens of submucosal invasive gastric carcinomas and the association with lymph node metastasis. The clinicopathological features of 144 cases of surgically resected submucosal invasive gastric carcinomas and their paired endoscopic biopsy specimens were reviewed. Immunohistochemical staining for MUC1 was performed for the 144 endoscopic biopsy specimens. Positive MUC1 expression was identified in 70 (49%) cases. In addition, univariate analysis revealed that MUC1 expression was significantly associated with the presence of poorly-differentiated (P=0.001) and poorly-cohesive (P=0.015) carcinoma cells, undifferentiated type by Japanese classification (P<0.001), diffuse type of Lauren classification (P<0.001) and lymph node metastasis (P=0.024). By multivariate analysis, diffuse type of Lauren classification (P<0.001) and lymph node metastasis (P=0.035) were identified as independent factors for MUC1 expression. Furthermore, MUC1 expression (P=0.007), tumor size (P=0.018) and lymphatic invasion (P<0.001) were demonstrated to be independent factors for lymph node metastasis under multivariate analysis. In conclusion, the results of the present study indicated that positive MUC1 expression in endoscopic biopsy specimens may be a predictive factor of lymph node metastasis in submucosal invasive gastric carcinoma.

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“…We recently published a study in which 3843 cases of surgically resected UD-type EGCs were examined, with particular emphasis placed on investigating the existence of LN metastasis [8]. Of those cases, 310 tumors satisfi ed our recently proposed criteria (lesion size ≤2 cm and no ulcerative component or lymphatic-vascular capillary involvement), with none of them having any LN metastasis.…”

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confidence: 99%

Lymph node metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria for endoscopic resection based on routine histological examination

et al. 2010

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primarily because of the successful development of endoscopic submucosal dissection (ESD) [1][2][3]. ER is minimally invasive and preserves the entire stomach, resulting in a better postoperative quality of life for patients [4,5]. ER is indicated for tumors with a negligible risk of lymph node (LN) metastasis [6]. Although the indications for ER specifi ed by the Japanese treatment guidelines are strictly limited to small mucosal tumors with differentiated histology (D-type), expanded indications for some D-type lesions (intramucosal cancers either ≤3 cm in size with no lymphatic-vascular capillary involvement regardless of ulceration fi ndings or with no ulceration regardless of tumor size) have been proposed and accepted by high-volume ER centers [2,6,7].It remains in dispute, however, as to which undifferentiated-type (UD-type) EGC lesions involve a negligible risk of LN metastasis. We recently published a study in which 3843 cases of surgically resected UD-type EGCs were examined, with particular emphasis placed on investigating the existence of LN metastasis [8]. Of those cases, 310 tumors satisfi ed our recently proposed criteria (lesion size ≤2 cm and no ulcerative component or lymphatic-vascular capillary involvement), with none of them having any LN metastasis. The risk of metastasis from such tumors was calculated to be 0-0.96% and we have proposed this as a new category of expanded criteria for ESD. Much to our surprise, immediately after the publication of this proposal, however, we encountered a patient satisfying all the expanded criteria based on routine histological examination, but who had, nonetheless, LN metastasis. Case reportA 58-year-old asymptomatic Japanese woman underwent screening abdominal ultrasonography that Abstract A 58-year-old woman was found to have a 45-mm abdominal mass adjacent to the pancreas on screening ultrasonography, and subsequent esophagogastroduodenoscopy revealed a small gastric cancer (13 mm in diameter). We initially performed endoscopic submucosal dissection (ESD), and routine histological examination of the specimen sectioned at 2-mm intervals revealed a poorly differentiated adenocarcinoma and signet ring cell carcinoma confi ned to the mucosa without lymphatic-vascular capillary involvement or ulceration. These fi ndings satisfi ed the expanded criteria for ESD we reported recently. We next performed laparoscopic excisional biopsy of the abdominal mass, and histological examination with immunohistochemical staining revealed a metastatic lymph node (LN) resulting from the gastric cancer. Distal gastrectomy with extended lymphadenectomy was then performed and histological examination indicated no residual cancer cells or any additional LN metastases. After the above-described clinical course, further analysis was conducted because of the highly unusual nature of this case; 60 additional deep-cut sections from the resected specimen were performed, with one section showing lymphatic involvement in the mucosa on hematoxylin and eosin staining. This case suggests p...

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Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Cited by 443 publications

References 36 publications

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Clinical validity of endoscopic submucosal dissection for submucosal invasive gastric cancer: a single-center study

Significance of MUC1 expression in biopsy specimens of submucosal invasive gastric carcinoma: The association with lymph node metastasis

Lymph node metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria for endoscopic resection based on routine histological examination

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