Risk Factors for lymph node metastasis in Undifferentiated-Type Gastric Carcinoma
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초록
Undifferentiated-type carcinoma has a high incidence of lymph node metastasis. The independent risk factors for lymph nodemetastasis in undifferentiated-type carcinoma are invasion depth, tumor size, lymphovascular invasion, and presence of ulcer. In thecases that meet the curative resection criteria, no lymph node metastasis was observed in the Japanese studies, but some metastaseswere observed in Korean studies. After performing curative endoscopic submucosal dissection, the survival rate is similar to thatof gastrectomy. The discrepancy between endoscopy and pathology is high in undifferentiated-type carcinoma. The tumor size inendoscopy is a significant risk factor for non-curative resection, and when the tumor size is small, the non-curative resection rate issignificantly reduced. Lymphovascular invasion can be assessed in pathologic examination and D2-40 stain is helpful. The presenceof ulcer should be determined by pathology, but ulcer’s omission in pathology report makes the analysis diffcult. Undifferentiatedtypecarcinomas with differentiated-type components show higher lymph node metastasis rate than that of pure undifferentiatedtypecarcinomas. The lymph node metastasis rate of signet ring cell type is lower than that of other undifferentiated-type carcinomasand is similar to differentiated-type carcinomas. The application of these additional histologic findings may improve the indication ofendoscopic submucosal dissection.
Abstract
Undifferentiated-type carcinoma has a high incidence of lymph node metastasis. The independent risk factors for lymph nodemetastasis in undifferentiated-type carcinoma are invasion depth, tumor size, lymphovascular invasion, and presence of ulcer. In thecases that meet the curative resection criteria, no lymph node metastasis was observed in the Japanese studies, but some metastaseswere observed in Korean studies. After performing curative endoscopic submucosal dissection, the survival rate is similar to thatof gastrectomy. The discrepancy between endoscopy and pathology is high in undifferentiated-type carcinoma. The tumor size inendoscopy is a significant risk factor for non-curative resection, and when the tumor size is small, the non-curative resection rate issignificantly reduced. Lymphovascular invasion can be assessed in pathologic examination and D2-40 stain is helpful. The presenceof ulcer should be determined by pathology, but ulcer’s omission in pathology report makes the analysis diffcult. Undifferentiatedtypecarcinomas with differentiated-type components show higher lymph node metastasis rate than that of pure undifferentiatedtypecarcinomas. The lymph node metastasis rate of signet ring cell type is lower than that of other undifferentiated-type carcinomasand is similar to differentiated-type carcinomas. The application of these additional histologic findings may improve the indication ofendoscopic submucosal dissection.
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