Incidence of lymphatic involvement in differentiated-type intramucosal gastric cancers as examined by endoscopic resection

Fujita, Yuka; Kishimoto, Mitsuo; Nakao, Ryuta; Kimura-Tsuchiya, Reiko; Yagi, Nobuaki; Yanagisawa, Akio

doi:10.1007/s10120-015-0465-4

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Regarding the prognosis of non-curative ESD cases, there are several previous studies comparing additional surgical procedure cases with follow-up cases [6, 7, 10-12]. Hoteya et al [11] reported that no LNM was observed in MGC in either group, and there was no difference in the survival rate between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics of Intramucosal Gastric Cancers with Lymphovascular Invasion Resected by Endoscopic Submucosal Dissection

et al. 2020

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Introduction: In patients with intramucosal gastric cancer (MGC) who have undergone endoscopic submucosal dissection (ESD), lymphovascular invasions (LVIs) such as lymphatic invasion or venous invasion are considered risk factors of lymph node metastasis (LNM). However, the rate of LNM in MGCs with LVI and their clinicopathological features are unclear. Objective: This study aimed to examine the rate of LNM and clinical characteristics of MGCs with LVI as compared to MGCs without LVI and minimally invasive submucosal gastric cancers (mSMGCs) with LVI. Methods: Among the early gastric cancers excluding the remnant stomach who underwent ESD at our hospital from July 2003 to September 2018, the MGCs with LVI were included as the target in this study. MGCs without LVI and mSMGCs with LVI were also included as control. Results: Seventeen lesions in 17 patients with MGCs with LVI, 1,149 lesions in 865 patients with MGCs without LVI, and 29 lesions in 29 patients with mSMGCs with LVI were analyzed. LVI was noted in 1.5% (17/1,166) of MGC cases. During follow-up of the MGC cases with LVI, there were no LNM or recurrences reported, and 14 patients survived and 3 died of other diseases. However, LNM occurred in 2 cases of mSMGC. Among the MGC cases, univariate analysis showed that the pap component, elevated type, and tumor diameters of 20 mm or more were statistically significant factors with respect to LVI, while multivariate analysis showed that the pap component was the only significant factor. Conclusion: Careful follow-up may be appropriate for MGCs with LVI due to the low risk of LNM. Additionally, the pap component is a significant factor in MGCs with LVI.

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Section: Discussionmentioning

confidence: 99%

“…Regarding MGCs with LVI, Fujita et al [7] reported 6 Ly-positive cases (2.0%) among 300 differentiated MGCs resected by ESD. After ESD, neither the 3 cases that underwent additional surgery, nor the 3 cases with follow-up reported LNM.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Intramucosal Gastric Cancers with Lymphovascular Invasion Resected by Endoscopic Submucosal Dissection

et al. 2020

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“…Diffuse or focal expression of any one of the three primitive markers was regarded as positive for primitive phenotype. D2–40 is a marker for lymphatic vessels, and cancer cells were confirmed to have lymphatic invasion if D2–40-positive cells surrounded the lumen [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

et al. 2021

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Background Certain gastric cancers exhibit some primitive phenotypes, which may indicate a high malignancy. In histologically differentiated early gastric cancer (EGC), the presence and the clinicopathological significance of the primitive phenotype remain unclear. Methods Using immunohistochemical staining we detected the expression of three primitive phenotypic markers SALL4, Glypican-3(GPC3), and AFP in whole tissue sections of differentiated EGC (gastrectomy specimens, n = 302). For those cases with primitive phenotypes, we analyzed their clinicopathological features and evaluated whether the criteria for endoscopic resection were met. Results We found that 9.3% (28/302) of all differentiated EGC cases have primitive phenotypes, and most of these cases (25/28) exhibit a histomorphology similar to conventional differentiated EGC. Patients with primitive phenotypes had a deeper invasion, a higher rate of ulcer and lymphatic invasion than cases without primitive phenotype. Moreover, patients with primitive phenotypes displayed a significantly higher frequency of LNM than those without (57.1% vs 8.8%, P < 0.001). Multivariate analysis revealed that presence of primitive phenotypes was an independent risk factor for LNM (P = 0.001, HR 6.977, 95% CI: 2.199–22.138). Interestingly, we found 2 cases with primitive phenotypes developed LNM, and they both met the expanded indications of endoscopic resection for differentiated EGC. Conclusions A small number of differentiated EGC have primitive phenotypes, which were closely related to LNM and were an independent risk factor for LNM. Given its highly aggressive behavior, differentiated EGC with primitive phenotypes should be evaluated with stricter criteria before endoscopic resection, or considered to give an additional surgical operation after endoscopic resection.

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“…After scanning titles and abstracts, 47 citations remained for full-text assessment. The search results and selection process are summarized in Fig 1 . Twenty-three studies were excluded for the following reasons: 9 studies did not include histological mixed-type classification [16,[26][27][28][29][30][31][32][33]; 6 did not directly mention the number of LNM cases [34][35][36][37][38][39]; 3 were considered to have unreliable data [40][41][42]; 2 were not confined to EGC [12,43]; and 3 were not accessible online. Finally, 24 studies were deemed eligible for the meta-analysis.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Relationship between histological mixed-type early gastric cancer and lymph node metastasis: A systematic review and meta-analysis

Yang

Tao

et al. 2022

PLoS ONE

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The clinicopathological features of early gastric cancer (EGC) with mixed-type histology (differentiated and undifferentiated) are incompletely understood, and the capacity of endoscopic submucosal dissection (ESD) to treat mixed-type cancer remains controversial. This systematic review analyzed the rate of lymph node metastasis (LNM) in mixed-type EGC. We gathered articles published up to February 21, 2021, that analyzed the relationship between LNM and mixed-type EGC from Embase, PubMed, and Web of Science. The primary outcome was the LNM rate associated with different histological types of EGC, and the secondary outcomes were the odds ratios (ORs) for LNM risk factors among EGC patients. From the 24 studies included in this meta-analysis, the overall rate of LNM in predominantly differentiated mixed-type (MD) EGC was 12%, whereas the LNM rate in predominantly undifferentiated mixed-type (MU) EGC was 22%. We further divided these studies into 2 groups according to the depth of invasion. In mixed-type mucosal EGC, the pooled LNM rate was 15%; in submucosal EGC, the rate was 33% for MU, which was higher than the rates for pure types (pure differentiated type, 13%; pure undifferentiated type, 21%; p<0.05). The LNM rate of MD was 20%, it was higher than those of the pure differentiated type and nearly the same as pure undifferentiated type. Other pooled statistics showed that submucosal invasion, pure undifferentiated EGC, and mixed-type EGC were independent risk factors for LNM. This meta-analysis showed that MD submucosal EGC has a high rate of LNM and is highly correlated with LNM; thus, the management of MD EGC as purely differentiated EGC according to the indications for ESD is inappropriate, and the mixed type should be added as a parameter in these indications.

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Incidence of lymphatic involvement in differentiated-type intramucosal gastric cancers as examined by endoscopic resection

Cited by 4 publications

References 25 publications

Clinical Characteristics of Intramucosal Gastric Cancers with Lymphovascular Invasion Resected by Endoscopic Submucosal Dissection

Clinical Characteristics of Intramucosal Gastric Cancers with Lymphovascular Invasion Resected by Endoscopic Submucosal Dissection

Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

Relationship between histological mixed-type early gastric cancer and lymph node metastasis: A systematic review and meta-analysis

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