Clin Endosc.  2017 Nov;50(6):569-577. 10.5946/ce.2017.017.

Therapeutic Outcomes of Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology: A Korean ESD Registry Database Analysis

Affiliations
  • 1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. baikgh@hallym.or.kr
  • 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
  • 6Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Korea.
  • 7Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
  • 8Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND/AIMS
To assess the therapeutic outcomes of endoscopic resection (ER) of early gastric cancer (EGC) with undifferentiated-type histology.
METHODS
Cases of ER of EGC with undifferentiated-type histology in the Korean endoscopic submucosal dissection (ESD) registry database were identified and reviewed. The immediate outcomes, including en bloc resection, complete resection, and curative resection rates, and long-term outcomes, including recurrence and survival rates, were extracted and analyzed.
RESULTS
From 2006 to 2015, 275 EGCs with undifferentiated-type histology from 275 patients were identified. The immediate outcomes were as follows: en bloc resection rate: 92.4%; complete resection rate: 80%; and curative resection rate: 36.4%. Compared to patients with lesions that were beyond the expanded indication, those with expanded indication lesions showed better therapeutic outcomes. There was no difference in immediate outcomes between patients with poorly differentiated adenocarcinoma (PDC) and signet ring cell carcinoma (SRC). However, compared to ER of SRC, ER of PDC had a stronger association with submucosal invasion (41.9% vs. 23.6%, p=0.003). With regard to long-term outcomes, there was no difference between lesions with curative and non-curative resections in the recurrence and mortality rates. These rates also did not differ between PDC and SRC (median follow up: 3.96 years).
CONCLUSIONS
ER confined to expanded indication lesions can be considered for treatment of EGC with undifferentiated-type histology.

Keyword

Endoscopic mucosal resection; Stomach neoplasms; Undifferentiated

MeSH Terms

Adenocarcinoma
Carcinoma, Signet Ring Cell
Follow-Up Studies
Humans
Mortality
Recurrence
Stomach Neoplasms*
Survival Rate

Figure

  • Fig. 1. Treatment flow of endoscopic resection of early gastric cancer with undifferentiated-type histology. ESD, endoscopic submucosal dissection; Op, operation.


Cited by  7 articles

Long-Term Outcomes of Endoscopic Submucosal Dissection of Undifferentiated-Type Early Gastric Cancer
Chang Seok Bang
Clin Endosc. 2021;54(2):143-144.    doi: 10.5946/ce.2021.044.

Pitfalls in the Interpretation of Publications about Endoscopic Submucosal Dissection of Early Gastric Cancer with Undifferentiated-Type Histology
Chang Seok Bang, Gwang Ho Baik
Clin Endosc. 2019;52(1):30-35.    doi: 10.5946/ce.2018.158.

Risk Factors for Lymph Node Metastasis in Undifferentiated-Type Gastric Carcinoma
Myeong-Cherl Kook
Clin Endosc. 2019;52(1):15-20.    doi: 10.5946/ce.2018.193.

Strategy for Curative Endoscopic Resection of Undifferentiated-Type Early Gastric Cancer
Jie-Hyun Kim
Clin Endosc. 2019;52(1):9-14.    doi: 10.5946/ce.2018.199.

Is Radical Surgery Necessary for All Patients Diagnosed as Having Non-Curative Endoscopic Submucosal Dissection?
Si Hyung Lee, Byung Sam Park
Clin Endosc. 2019;52(1):21-29.    doi: 10.5946/ce.2019.014.

Aberrant Expression of Epithelial-Mesenchymal Transition Markers in Early Gastric Cancer: Clinical Application
Moon Kyung Joo
Clin Endosc. 2019;52(5):393-394.    doi: 10.5946/ce.2019.139.

Endoscopic Resection of Early Gastric Cancer with Undifferentiated-Type Histology
Jie-Hyun Kim
Clin Endosc. 2017;50(6):511-513.    doi: 10.5946/ce.2017.168.


Reference

1. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007; 10:1–11.
Article
2. Soetikno R, Kaltenbach T, Yeh R, Gotoda T. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol. 2005; 23:4490–4498.
Article
3. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000; 3:219–225.
Article
4. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.
Article
5. Lee JH, Kim JG, Jung HK, et al. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer. 2014; 14:87–104.
Article
6. Katsube T, Konnno S, Hamaguchi K, et al. The efficacy of endoscopic mucosal resection in the diagnosis and treatment of group III gastric lesions. Anticancer Res. 2005; 25:3513–3516.
7. Bang CS, Baik GH, Shin IS, et al. Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology: a meta-analysis. World J Gastroenterol. 2015; 21:6032–6043.
Article
8. Ajani JA, D’Amico TA, Almhanna K, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016; 14:1286–1312.
9. Kim JH, Kim YH, Jung da H, et al. Follow-up outcomes of endoscopic resection for early gastric cancer with undifferentiated histology. Surg Endosc. 2014; 28:2627–2633.
Article
10. Ahn JY, Park HJ, Park YS, et al. Endoscopic resection for undifferentiated-type early gastric cancer: immediate endoscopic outcomes and longterm survivals. Dig Dis Sci. 2016; 61:1158–1164.
Article
11. Oka S, Tanaka S, Higashiyama M, et al. Clinical validity of the expanded criteria for endoscopic resection of undifferentiated-type early gastric cancer based on long-term outcomes. Surg Endosc. 2014; 28:639–647.
Article
12. Min BH, Kang KJ, Lee JH, et al. Endoscopic resection for undifferentiated early gastric cancer: focusing on histologic discrepancies between forceps biopsy-based and endoscopic resection specimen-based diagnosis. Dig Dis Sci. 2014; 59:2536–2543.
Article
13. Kang HY, Kim SG, Kim JS, Jung HC, Song IS. Clinical outcomes of endoscopic submucosal dissection for undifferentiated early gastric cancer. Surg Endosc. 2010; 24:509–516.
Article
14. Gong S, Xue HB, Ge ZZ, et al. Value of magnifying endoscopy with narrow-band imaging and confocal laser endomicroscopy in detecting gastric cancerous lesions. Medicine (Baltimore). 2015; 94:e1930.
Article
15. Hirasawa T, Gotoda T, Miyata S, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer. 2009; 12:148–152.
Article
16. Kumarasinghe MP, Lim TK, Ooi CJ, Luman W, Tan SY, Koh M. Tubule neck dysplasia: precursor lesion of signet ring cell carcinoma and the immunohistochemical profile. Pathology. 2006; 38:468–471.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr