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, 24 (1), 87-95

Differential Analysis of Lymph Node Metastasis in Histological Mixed-Type Early Gastric Carcinoma in the Mucosa and Submucosa


Differential Analysis of Lymph Node Metastasis in Histological Mixed-Type Early Gastric Carcinoma in the Mucosa and Submucosa

Qian Zhong et al. World J Gastroenterol.


Aim: To investigate the relationship between histological mixed-type of early gastric cancer (EGC) in the mucosa and submucosa and lymph node metastasis (LNM).

Methods: This study included 298 patients who underwent gastrectomy for EGC between 2005 and 2012. Enrolled lesions were divided into groups of pure differentiated (pure D), pure undifferentiated (pure U), and mixed-type according to the proportion of the differentiated and undifferentiated components observed under a microscope. We reviewed the clinicopathological features, including age, sex, location, size, gross type, lymphovascular invasion, ulceration, and LNM, among the three groups. Furthermore, we evaluated the predictors of LNM in the mucosa-confined EGC.

Results: Of the 298 patients, 165 (55.4%) had mucosa-confined EGC and 133 (44.6%) had submucosa-invasive EGC. Only 13 (7.9%) cases of mucosa-confined EGC and 30 (22.6%) cases of submucosa-invasive EGC were observed to have LNM. The submucosal invasion (OR = 4.58, 95%CI: 1.23-16.97, P = 0.023), pure U type (OR = 4.97, 95%CI: 1.21-20.39, P = 0.026), and mixed-type (OR = 5.84, 95%CI: 1.05-32.61, P = 0.044) were independent risk factors for LNM in EGC. The rate of LNM in mucosa-confined EGC was higher in the mixed-type group (P = 0.012) and pure U group (P = 0.010) than in the pure D group, but no significant difference was found between the mixed-type group and pure U group (P = 0.739). Similarly, the rate of LNM in the submucosa-invasive EGC was higher in the mixed-type (P = 0.012) and pure U group (P = 0.009) than in the pure D group but was not significantly different between the mixed-type and pure U group (P = 0.375). Multivariate logistic analysis showed that only female sex (OR = 5.83, 95%CI: 1.64-20.70, P = 0.028) and presence of lymphovascular invasion (OR = 13.18, 95%CI: 1.39-125.30, P = 0.020) were independent risk factors for LNM in mucosa-confined EGC, while histological type was not an independent risk factor for LNM in mucosa-confined EGC (P = 0.106).

Conclusion: For mucosal EGC, histological mixed-type is not an independent risk factor for LNM and could be managed in the same way as the undifferentiated type.

Keywords: Early gastric carcinoma; Lymph node metastasis; Lymphovascular invasion; Mixed-type; Mucosa.

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to disclose.


Figure 1
Figure 1
The relationship among the histological classifications of early gastric cancer in the mucosa and submucosa. Of the 298 cases, there were 212 with differentiated type gastric cancer and 86 with undifferentiated type gastric cancer based on the Japanese classification currently used as the endoscopic resection criteria. In accordance with the WHO classification, there were 188 patients with differentiated type and 110 patients with undifferentiated type gastric cancer. According to the histological differentiation and undifferentiation components, 41 patients were reclassified as mixed-type. For mucosal early gastric cancer (EGC), there were 99 patients in the pure differentiated (pure D) group, 9 in the differentiated > undifferentiated (D > U) group, 8 in the undifferentiated > differentiated (U > D) group, and 49 in the pure undifferentiated (pure U) group. For submucosal EGC, there were 89 in the pure D group, 15 in the D > U group, 9 in the U > D group, and 20 in the pure U group. Among the 41 patients with mixed-type EGC, there were 17 in the mucosa and 24 in the submucosa. D: Differentiated; M: Mucosa; SM: Submucosa; U: Undifferentiated.

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