A Risk Assessment Of Lymph Node Metastasis Histological In Mixed-type Early Gastric Carcinoma

Background and objectiveEarly gastric cancer with histological mixed-type consists of differentiated and undifferentiated components.The histological mixed-type(MT)early gastric cancer(EGC)was related to the aggressive clinical features and poor outcomes.No consensus has been reached on which lesions in histological mixed-type EGC present a negligible risk for lymph node metastasis,and nor have indications for endoscopic resection(ER)for histological mixed-type EGC been established.This study aimed to clarify incidence of lymph node metastasis and the feasibility of histological MT EGC in mucosa and submucosa.MethodsThis study included 298 patients who had undergone gastrectomy for EGC between 2005 and 2012 from their hospital records.These patients were divided into three groups with PU(pure undifferentiated),PD(pure differentiated)and MT(mixed-type)EGC.Clinicopathological features among three types of EGC were compared in mucosa and submucosa respectively,and clinicopathological factors were assessed for their possible association with lymph node metastasis.ResultsOf the 298 patients,165(55.4%)had mucosal cancers and 133(44.6%)had submucosal invasive cancers.The rate of LNM was 7.9%in mucosa and 22.6%in submucosa.Patients with MT carcinomas were more common in female,middle or lower third,ulcer,Helicobacter pylori(HP)and LNM than those with PU or PD carcinomas in mucosa.When invasion of depth in submucosa,patients with MT carcinomas were less likely to have younger female,middle or lower third,non elevated gross type and LNM than those with PU carcinomas.Multivariate logistic regression analysis revealed that female sex and lymphovascular invasion were significant predictors of LNM in mucosa(P<0.05).The significant predictors of LNM were histological type,location and lymphovascular invasion in submucosa(P<0.05).ConclusionsLNM was not significantly related with histological type in mucosa,however,histological type was the significant predictor of LNM in submucosa.Therefore,MT carcinomas in mucosa could be managed with ER.