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Mixed Histologic Type is a Risk Factor for Lymph Node Metastasis in Submucosal Invasive Early Gastric Cancer

  • Author Footnotes
    1 These authors have contributed equally to this work.
    Feng Sun
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Author Footnotes
    1 These authors have contributed equally to this work.
    Song Zhang
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this work.
    Xingzhou Wang
    Footnotes
    1 These authors have contributed equally to this work.
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Ming Yao
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Chen Zhang
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Zhijian Liu
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Shichao Ai
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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  • Wenxian Guan
    Correspondence
    Corresponding author. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China. Tel.: +86 25 68182098.
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
    Search for articles by this author
  • Meng Wang
    Correspondence
    Corresponding author. Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China. Tel.: +86 25 68182098.
    Affiliations
    Department of Gastrointestinal Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
    Search for articles by this author
  • Author Footnotes
    1 These authors have contributed equally to this work.
Published:October 25, 2022DOI:https://doi.org/10.1016/j.jss.2022.09.013

      Abstract

      Introduction

      The treatment regimen for early gastric cancer (EGC) with mixed histologic type remains controversial. We aimed to clarify the relationship between mixed histologic type and lymph node metastasis (LNM) in EGC, with emphasis on submucosal invasive EGC.

      Methods

      We collected data on 730 consecutive EGC patients at Nanjing Drum Tower hospital between June 2010 and May 2019. Risk factors of LNM and overall survival were analyzed to compare the prognostic differences between different histologic types.

      Results

      Mixed-type EGC patients had higher LNM rates than differentiated-type patients (29.2 % versus 10.6 %, P < 0.001), while no significant difference was found between mixed-type and undifferentiated-type EGC patients (29.2% versus 24.0%, P = 0.225). Multivariate analyses identified tumor location (cardiac and bottom versus antrum), larger tumor size, submucosal invasion, histologic differentiation (undifferentiated-type, mixed-type versus differentiated-type), and lymphovascular invasion as independent risk factors for LNM in EGC patients. Subgroup analysis further elucidated that mixed histologic type was associated with LNM in submucosa invasive EGC, but not in mucosa-confined EGC. There was no statistical significance in overall survival and disease-specific survival of submucosal invasive EGC patients who underwent radical gastrectomy with lymphadenectomy between different histologic types (P = 0.151).

      Conclusions

      Mixed histologic type may be an independent risk factor for LNM in submucosal invasive EGC. Curative resection with lymphadenectomy should be considered the appropriate treatment for submucosal invasive EGC with mixed histologic type.

      Keywords

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