Choi, Chung, Kim, Kim, Kim, Jung (2019) Determining the current indications for endoscopic submucosal dissection in patients with Lauren mixed-type early gastric cancer Journal of gastroenterology and hepatology ()
Recent study showed that early gastric cancer (EGC) with Lauren Mixed type (MT) histology is associated with worse prognosis. We aimed to evaluate the clinicopathologic features and prognostic significance of Lauren MT-EGCs that meets the criteria for endoscopic submucosal dissection (ESD). We reviewed 2,665 patients with EGC who underwent surgery between 2010 and 2015. The clinicopathologic features and invasiveness including lymph node metastasis (LNM) and lymphovascular invasion (LVI) of MT-EGC were compared with those of intestinal type (IT) and diffuse type (DT) by Lauren histology. Among 2,665 patients, EGCs in 241 (9%) patients were classified as MT. Tumor size was larger and depth of invasion was greater than other histology. Among patients with MT-EGC, 16.6% (40/241) showed LNM and 22.8% (55/241) showed lymphatic invasion, which were significantly higher than that of patients with other Lauren types (8.2%, 15.3% in IT, 9.1%, 8.7% in DT, p<0.001). This finding remained significant even after adjusting for depth of invasion. However, when we analyzed the patient groups who met the absolute or expanded criteria of ESD, no significant difference was observed in the rates of LNM or LVI or cancer mortality by Lauren classification. MT-EGC exhibited larger tumor size, greater depth of invasion, and higher risk of LNM and LVI. However, among the patients who met the absolute or expanded criteria of ESD, no significant difference was observed in LNM, LVI, and gastric cancer mortality risk. This article is protected by copyright. All rights reserved.