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- Title
Clinicopathologic features of early gastric carcinoma with lymphoid stroma and feasibility of endoscopic submucosal dissection.
- Authors
Shin, Dong; Kim, Gwang; Lee, Bong; Lee, Jong; Ha, Dong; Jeon, Hye; Baek, Dong; Song, Geun; Ahn, Sang; Park, Do; Shin, Dong Hun; Kim, Gwang Ha; Lee, Bong Eun; Lee, Jong Wook; Ha, Dong Woo; Jeon, Hye Kyung; Baek, Dong Hoon; Song, Geun Am; Ahn, Sang Jeong; Park, Do Youn
- Abstract
<bold>Background: </bold>Gastric carcinoma with lymphoid stroma (GCLS) is a rare disease known to have unique features and a favorable prognosis. This study aimed to determine the clinicopathologic features of early GCLS (EGCLS) and define the feasibility of endoscopic submucosal dissection (ESD) for EGCLS.<bold>Methods: </bold>We performed a retrospective analysis of 70 EGCLS patients treated via ESD or surgery and 1626 patients who underwent surgical resection for early non-GCLS (ENGCLS) between January 2007 and December 2014 at Pusan National University Hospital, Busan, Republic of Korea.<bold>Results: </bold>The mean age of EGCLS patients was 58 years (range 36-77 years); a male predominance (3.7:1) was observed, and 81.4% showed Epstein-Barr virus positivity. Compared with ENGCLS, EGCLS was macroscopically more elevated (34.3 vs. 18.0%, P = 0.003) and located more proximally (upper third: 37.1 vs. 9.7%, P < 0.001). Tumor size was smaller (2.1 ± 1.1 vs. 3.1 ± 2.0 cm, P < 0.001), but submucosal invasion was more frequent (77.1 vs. 44.4%, P < 0.001) and deeper in the EGCLS group. Among the 59 EGCLS patients who were treated surgically, only two (3.4%) showed lymph node metastasis (LNM). Despite submucosal invasion, EGCLS showed a lower LNM rate (4.0 vs. 19.4%, P = 0.007) than ENGCLS, even in patients with SM3 EGCLS (5.3 vs. 24.5%, P = 0.007). There were no recurrences in the available ten patients who underwent ESD alone during a mean follow-up of 37.2 months.<bold>Conclusions: </bold>In this study, we observed unique clinicopathologic features with a very low LNM rate in EGCLS. We consider ESD a potentially curative treatment strategy for EGCLS despite deep submucosal invasion, especially in patients with poor performance status and significant comorbidities.
- Subjects
SOUTH Korea; STOMACH cancer treatment; ENDOSCOPIC surgery; RARE diseases; SURGICAL excision; EPSTEIN-Barr virus diseases; ADENOCARCINOMA; CONNECTIVE tissues; GASTRECTOMY; GASTRIC mucosa; LYMPH nodes; LYMPH node surgery; LYMPHOCYTES; METASTASIS; STOMACH tumors; TUMOR classification; PILOT projects; RETROSPECTIVE studies; EARLY detection of cancer; SURGERY
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2017, Vol 31, Issue 10, p4156
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-017-5470-8