title: The risk of lymph node metastasis in mucosal gastric carcinoma: especially for a mixture of differentiated and undifferentiated adenocarcinoma.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is gaining wider acceptance for the treatment of early gastric carcinoma (EGC) and its indication has been extended to mucosal gastric carcinoma with undifferentiated component in some institutes. Our aims were to confirm the frequency of lymph node metastasis in such cases and clarify the demarcation in indications for ESD.
  
  
  METHODS
  We evaluated medical data of 287 patients with mucosal gastric carcinoma who underwent surgical resection between 1996 and 2008. The tumours were histologically classified into purely differentiated (PD), differentiated-predominant mixed (DPM), undifferentiated-predominant mixed (UPM) and purely undifferentiated (PU) types.
  
  
  RESULTS
  Lymph node metastasis was identified in seven (2.4%) of the 287 patients and was detected more frequently in UPM (10%, two of 20) and PU (4%, four of 98), compared with PD (none of 148) (p=0.01 and 0.02, respectively). In mixed-type carcinoma, size was a significant risk factor for lymph node metastasis (p=0.04).
  
  
  CONCLUSIONS
  It might be better to select gastrectomy rather than ESD for the treatment of mucosal gastric carcinoma with an undifferentiated component.
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Kohei
authors: K
authors: Nakata
authors: Eishi
authors: E
authors: Nagai
authors: Yoshihiro
authors: Y
authors: Miyasaka
authors: Kenoki
authors: K
authors: Ohuchida
authors: Takao
authors: T
authors: Ohtsuka
authors: Hiroki
authors: H
authors: Toma
authors: Minako
authors: M
authors: Hirahashi
authors: Shinichi
authors: S
authors: Aishima
authors: Yoshinao
authors: Y
authors: Oda
authors: Masao
authors: M
authors: Tanaka
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007564:Japan; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery