title: Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability.
abstract: OBJECTIVE
  To investigate endoscopic and clinicopathologic characteristics of early gastric cancer (EGC) according to microsatellite instability phenotype.
  
  
  METHODS
  Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability (MSI) mutation [high MSI (MSI-H)] and 146 consecutive EGC patients with one or no MSI mutation (non-MSI-H) were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.
  
  
  RESULTS
  In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern (OR 4.38, 95% CI: 2.40-8.01, P < 0.001), moderate-to-severe atrophy in the surrounding mucosa (OR 1.91, 95% CI: 1.05-3.47, P = 0.033), antral location (OR 3.99, 95% CI: 2.12-7.52, P < 0.001) and synchronous lesions, compared to non-MSI-H EGCs (OR 2.65, 95% CI: 1.16-6.07, P = 0.021). Other significant clinicopathologic characteristics of MSI-H EGC included predominance of female sex (OR 2.77, 95% CI: 1.53-4.99, P < 0.001), older age (> 70 years) (OR 3.30, 95% CI: 1.57-6.92, P = 0.002), better histologic differentiation (OR 2.35, 95% CI: 1.27-4.34, P = 0.007), intestinal type by Lauren classification (OR 2.34, 95% CI: 1.15-4.76, P = 0.019), absence of a signet ring cell component (OR 2.44, 95% CI: 1.02-5.86, P = 0.046), presence of mucinous component (OR 5.06, 95% CI: 1.27-20.17, P = 0.022), moderate-to-severe lymphoid stromal reaction (OR 3.95, 95% CI: 1.59-9.80, P = 0.003), and co-existing underlying adenoma (OR 2.66, 95% CI: 1.43-4.95, P = 0.002).
  
  
  CONCLUSIONS
  MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics including frequent presentation in protruded type, co-existing underlying adenoma, and synchronous lesions.
authors: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, South Korea.
authors: Jaehoon
authors: J
authors: Jahng
authors: Young Hoon
authors: YH
authors: Youn
authors: Kwang Hyun
authors: KH
authors: Kim
authors: Junghwan
authors: J
authors: Yu
authors: Yong Chan
authors: YC
authors: Lee
authors: Woo Jin
authors: WJ
authors: Hyung
authors: Sung Hoon
authors: SH
authors: Noh
authors: Hyunki
authors: H
authors: Kim
authors: Hogeun
authors: H
authors: Kim
authors: Hyojin
authors: H
authors: Park
authors: Sang In
authors: SI
authors: Lee
mesh_terms: D000236:Adenoma / Q000235:genetics / Q000473:pathology; D000368:Aged; D001284:Atrophy; D001706:Biopsy; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D020022:Genetic Predisposition to Disease; D006801:Humans; D016015:Logistic Models; D008297:Male; D008679:Metaplasia; D053842:Microsatellite Instability; D008875:Middle Aged; D009154:Mutation; D009361:Neoplasm Invasiveness; D016017:Odds Ratio; D010641:Phenotype; D011237:Predictive Value of Tests; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000235:genetics* / Q000473:pathology*