Gut Liver.  2021 Jan;15(1):44-52. 10.5009/gnl19328.

Clinicopathologic Features of Submucosal Papillary Gastric Cancer Differ from Those of Other Differentiated-Type Histologies

Affiliations
  • 1Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
  • 3Department of Pathology, Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 4Department of Pathology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
  • 5St. Maria Pathology Laboratory, Busan, Korea
  • 6Departments of Surgery, Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 7Departments of Internal Medicine, Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 8Departments of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 9Departments of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 10Departments of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background/Aims
Papillary gastric cancer (GC) is classified as differentiated adenocarcinoma, together with well-differentiated (WD) and moderately differentiated (MD) adenocarcinoma. This study evaluated the risk of lymph node metastasis (LNM) in submucosal (SM) invasive papillary GC compared with other differentiated early GC types.
Methods
This retrospective study involved three tertiary hospitals and enrolled 1,798 lesions with differentiated SM invasive GC treated with curative gastrectomy between March 2001 and December 2012. All pathology slides were reviewed, and clinicopathologic findings associated with LNM, including tumor size, location, gross type, ulceration, depth and width of SM invasion, and lymphovascular invasion (LVI), were analyzed.
Results
The proportion of SM papillary GC was 2.8% (n=51). SM papillary GC was associated with larger tumor size and deeper and wider SM invasion than other differentiated GC types. LNM was significantly higher in the papillary type than in the MD and WD types. LNM was found in 27.5% of SM papillary GC patients (WD: 9.0%, MD: 21.2%). LVI was the only significant risk factor for LNM in SM papillary GC. The depth or width of SM invasion was not associated with LNM in papillary GC. Lower third location or elevated gross appearance was significantly associated with LVI.
Conclusions
SM papillary GC had the highest LNM rate, with features different from those of other differentiated SM invasive GCs. The treatment strategy for SM papillary GC should be carefully approached, especially for lesions located in the lower third or of the elevated gross type.

Keyword

Stomach neoplasm; Adenocarcinoma; papillary; Lymphatic metastasis; Risk factors
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