title: Prognostic significance of neuroendocrine components in gastric carcinomas.
abstract: BACKGROUND
  Gastric neuroendocrine carcinomas (NECs) and mixed adenoneuroendocrine carcinomas (MANECs) are aggressive tumours but the prognostic significance of a neuroendocrine component in <30% of the tumour remains unclear. Here, the implication of neuroendocrine components in gastric carcinomas was assessed according to proportion.
  
  
  METHODS
  Surgically resected primary gastric carcinomas with neuroendocrine morphology (NEM; n=88) from 2000 to 2012 at Asan Medical Center were retrospectively reviewed. Neuroendocrine differentiation (NED) was defined as immunopositivity for one of three neuroendocrine markers (synaptophysin, chromogranin or CD56) within the NEM area. To validate the prognostic significance of NED, these cases were compared with 650 randomly selected gastric adenocarcinomas without NEM from the same time period.
  
  
  RESULTS
  Gastric carcinomas with NEM were reclassified as NEC (⩾70% NED, n=47), MANEC (30-70% NED, n=10), gastric carcinoma with 10-30% NED (GCNED, n=8) and carcinoma with <10% NED (n=23). The survival rates of patients with ⩾10% NED were significantly poorer than those with <10% NED but no survival difference was observed between NEC and MANEC. In univariate analyses, older age (⩾60years), larger tumour size (⩾4cm), advanced stage group, ⩾10% NED and lymphovascular or perineural invasion were indicative of a poor prognosis. Stage group and ⩾10% NED remained as independent prognostic factors by multivariate analysis.
  
  
  CONCLUSIONS
  A minor proportion (10-30%) of NED should not be overlooked in gastric carcinomas with NEM. NED should be carefully evaluated to predict patient outcomes and plan optimal additional therapies.
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Ji Y
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Min-Hee
authors.initials: MH
authors.lastname: Ryu
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea. Electronic address: youngspark@amc.seoul.kr.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Baek-Yeol
authors.initials: BY
authors.lastname: Ryoo
authors.affiliation: Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, Gyeonggi-do 471-701, Republic of Korea.
authors.forename: Min Gyu
authors.initials: MG
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Yook
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 138-736, Republic of Korea.
authors.forename: Yoon-Koo
authors.initials: YK
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D019002:CD56 Antigen / Q000378:metabolism; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis* / Q000601:surgery*; D002454:Cell Differentiation; D053379:Chromogranin A / Q000378:metabolism; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D016708:Synaptophysin / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D019002:CD56 Antigen; D053379:Chromogranin A; C522918:NCAM1 protein, human; D016708:Synaptophysin
keywords: Component; Gastric carcinoma; Neuroendocrine; Prognosis; Proportion