Histologic purity of signet ring cell carcinoma is a favorable risk factor for lymph node metastasis in poorly cohesive, submucosa-invasive early gastric carcinoma

Yon Hee Kim, Ji Hye Park, Cheol Keun Park, Jie-Hyun Kim, SangKil Lee, Yongchan Lee, Sung Hoon Noh, Hyunki Kim

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The prediction of biologic behavior of poorly cohesive early gastric carcinoma (EGC) is an important issue in the selection of the treatment modality. To elucidate the risk factors for lymph node metastasis (LNM) of poorly cohesive EGC, we focused on the histologic purity of the poorly cohesive component and evaluated the impact of this factor on LNM. Methods: We divided poorly cohesive EGC into (1) pure signet ring cell (SRC) carcinoma, which was defined as composed only of signet ring cells or poorly cohesive cells and (2) mixed SRC carcinoma, defined as poorly cohesive carcinoma with minor tubular components. We reviewed the clinicopathologic features, including age, sex, location, size, depth, lymphovascular invasion (LVI), LNM, ulceration, and intestinal metaplasia between the two groups in a large series of poorly cohesive, submucosa-invasive EGC (n = 317). Results: LNM was found in 58 cases (18.3 %). Mixed SRC carcinoma histologic type (p < 0.001), larger tumor size (more than 2 cm) (p = 0.012), and the presence of LVI (p < 0.001) were associated with LNM. Pure SRC carcinomas accounted for 56.2 % (178/317) of the cases. Fourteen pure SRC carcinomas (7.8 %) showed LNM, whereas 44 mixed SRC carcinomas (31.9 %) exhibited LNM (p < 0.001). On multivariate logistic regression, the presence of LVI (odds ratio 6.737; 95 % confidence interval 2.714–16.720; p < 0.001) and mixed SRC carcinoma histologic type (odds ratio 4.674; 95 % confidence interval 2.370–9.216; p < 0.001) were independent predictors of LNM in poorly cohesive, submucosa-invasive EGC. Conclusions: The presence of a tubular component in SRC carcinoma was a risk factor for LNM in poorly cohesive, submucosa-invasive EGC. On the basis of this finding, we propose that the presence of a minor tubular component or the purity of the poorly cohesive/SRC carcinoma component should be reported in daily pathologic practice.

Original languageEnglish
Pages (from-to)583-590
Number of pages8
JournalGastric Cancer
Volume20
Issue number4
DOIs
Publication statusPublished - 2017 Jul 1

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Signet Ring Cell Carcinoma
Stomach
Lymph Nodes
Neoplasm Metastasis
Carcinoma
Odds Ratio
Confidence Intervals
Metaplasia
Cellular Structures
Logistic Models

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

@article{ddf52fcf91ce4708b5b8f74e7239faa4,
title = "Histologic purity of signet ring cell carcinoma is a favorable risk factor for lymph node metastasis in poorly cohesive, submucosa-invasive early gastric carcinoma",
abstract = "Background: The prediction of biologic behavior of poorly cohesive early gastric carcinoma (EGC) is an important issue in the selection of the treatment modality. To elucidate the risk factors for lymph node metastasis (LNM) of poorly cohesive EGC, we focused on the histologic purity of the poorly cohesive component and evaluated the impact of this factor on LNM. Methods: We divided poorly cohesive EGC into (1) pure signet ring cell (SRC) carcinoma, which was defined as composed only of signet ring cells or poorly cohesive cells and (2) mixed SRC carcinoma, defined as poorly cohesive carcinoma with minor tubular components. We reviewed the clinicopathologic features, including age, sex, location, size, depth, lymphovascular invasion (LVI), LNM, ulceration, and intestinal metaplasia between the two groups in a large series of poorly cohesive, submucosa-invasive EGC (n = 317). Results: LNM was found in 58 cases (18.3 {\%}). Mixed SRC carcinoma histologic type (p < 0.001), larger tumor size (more than 2 cm) (p = 0.012), and the presence of LVI (p < 0.001) were associated with LNM. Pure SRC carcinomas accounted for 56.2 {\%} (178/317) of the cases. Fourteen pure SRC carcinomas (7.8 {\%}) showed LNM, whereas 44 mixed SRC carcinomas (31.9 {\%}) exhibited LNM (p < 0.001). On multivariate logistic regression, the presence of LVI (odds ratio 6.737; 95 {\%} confidence interval 2.714–16.720; p < 0.001) and mixed SRC carcinoma histologic type (odds ratio 4.674; 95 {\%} confidence interval 2.370–9.216; p < 0.001) were independent predictors of LNM in poorly cohesive, submucosa-invasive EGC. Conclusions: The presence of a tubular component in SRC carcinoma was a risk factor for LNM in poorly cohesive, submucosa-invasive EGC. On the basis of this finding, we propose that the presence of a minor tubular component or the purity of the poorly cohesive/SRC carcinoma component should be reported in daily pathologic practice.",
author = "Kim, {Yon Hee} and Park, {Ji Hye} and Park, {Cheol Keun} and Jie-Hyun Kim and SangKil Lee and Yongchan Lee and Noh, {Sung Hoon} and Hyunki Kim",
year = "2017",
month = "7",
day = "1",
doi = "10.1007/s10120-016-0645-x",
language = "English",
volume = "20",
pages = "583--590",
journal = "Gastric Cancer",
issn = "1436-3291",
publisher = "Springer Japan",
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}

Histologic purity of signet ring cell carcinoma is a favorable risk factor for lymph node metastasis in poorly cohesive, submucosa-invasive early gastric carcinoma. / Kim, Yon Hee; Park, Ji Hye; Park, Cheol Keun; Kim, Jie-Hyun; Lee, SangKil; Lee, Yongchan; Noh, Sung Hoon; Kim, Hyunki.

In: Gastric Cancer, Vol. 20, No. 4, 01.07.2017, p. 583-590.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Histologic purity of signet ring cell carcinoma is a favorable risk factor for lymph node metastasis in poorly cohesive, submucosa-invasive early gastric carcinoma

AU - Kim, Yon Hee

AU - Park, Ji Hye

AU - Park, Cheol Keun

AU - Kim, Jie-Hyun

AU - Lee, SangKil

AU - Lee, Yongchan

AU - Noh, Sung Hoon

AU - Kim, Hyunki

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background: The prediction of biologic behavior of poorly cohesive early gastric carcinoma (EGC) is an important issue in the selection of the treatment modality. To elucidate the risk factors for lymph node metastasis (LNM) of poorly cohesive EGC, we focused on the histologic purity of the poorly cohesive component and evaluated the impact of this factor on LNM. Methods: We divided poorly cohesive EGC into (1) pure signet ring cell (SRC) carcinoma, which was defined as composed only of signet ring cells or poorly cohesive cells and (2) mixed SRC carcinoma, defined as poorly cohesive carcinoma with minor tubular components. We reviewed the clinicopathologic features, including age, sex, location, size, depth, lymphovascular invasion (LVI), LNM, ulceration, and intestinal metaplasia between the two groups in a large series of poorly cohesive, submucosa-invasive EGC (n = 317). Results: LNM was found in 58 cases (18.3 %). Mixed SRC carcinoma histologic type (p < 0.001), larger tumor size (more than 2 cm) (p = 0.012), and the presence of LVI (p < 0.001) were associated with LNM. Pure SRC carcinomas accounted for 56.2 % (178/317) of the cases. Fourteen pure SRC carcinomas (7.8 %) showed LNM, whereas 44 mixed SRC carcinomas (31.9 %) exhibited LNM (p < 0.001). On multivariate logistic regression, the presence of LVI (odds ratio 6.737; 95 % confidence interval 2.714–16.720; p < 0.001) and mixed SRC carcinoma histologic type (odds ratio 4.674; 95 % confidence interval 2.370–9.216; p < 0.001) were independent predictors of LNM in poorly cohesive, submucosa-invasive EGC. Conclusions: The presence of a tubular component in SRC carcinoma was a risk factor for LNM in poorly cohesive, submucosa-invasive EGC. On the basis of this finding, we propose that the presence of a minor tubular component or the purity of the poorly cohesive/SRC carcinoma component should be reported in daily pathologic practice.

AB - Background: The prediction of biologic behavior of poorly cohesive early gastric carcinoma (EGC) is an important issue in the selection of the treatment modality. To elucidate the risk factors for lymph node metastasis (LNM) of poorly cohesive EGC, we focused on the histologic purity of the poorly cohesive component and evaluated the impact of this factor on LNM. Methods: We divided poorly cohesive EGC into (1) pure signet ring cell (SRC) carcinoma, which was defined as composed only of signet ring cells or poorly cohesive cells and (2) mixed SRC carcinoma, defined as poorly cohesive carcinoma with minor tubular components. We reviewed the clinicopathologic features, including age, sex, location, size, depth, lymphovascular invasion (LVI), LNM, ulceration, and intestinal metaplasia between the two groups in a large series of poorly cohesive, submucosa-invasive EGC (n = 317). Results: LNM was found in 58 cases (18.3 %). Mixed SRC carcinoma histologic type (p < 0.001), larger tumor size (more than 2 cm) (p = 0.012), and the presence of LVI (p < 0.001) were associated with LNM. Pure SRC carcinomas accounted for 56.2 % (178/317) of the cases. Fourteen pure SRC carcinomas (7.8 %) showed LNM, whereas 44 mixed SRC carcinomas (31.9 %) exhibited LNM (p < 0.001). On multivariate logistic regression, the presence of LVI (odds ratio 6.737; 95 % confidence interval 2.714–16.720; p < 0.001) and mixed SRC carcinoma histologic type (odds ratio 4.674; 95 % confidence interval 2.370–9.216; p < 0.001) were independent predictors of LNM in poorly cohesive, submucosa-invasive EGC. Conclusions: The presence of a tubular component in SRC carcinoma was a risk factor for LNM in poorly cohesive, submucosa-invasive EGC. On the basis of this finding, we propose that the presence of a minor tubular component or the purity of the poorly cohesive/SRC carcinoma component should be reported in daily pathologic practice.

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U2 - 10.1007/s10120-016-0645-x

DO - 10.1007/s10120-016-0645-x

M3 - Article

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EP - 590

JO - Gastric Cancer

JF - Gastric Cancer

SN - 1436-3291

IS - 4

ER -