title: Long-term outcomes of early gastric cancer diagnosed as mixed adenocarcinoma after endoscopic submucosal dissection.
abstract: OBJECTIVE
  The clinical significance and prognosis of mixed adenocarcinoma in early gastric cancer (EGC) are incompletely understood. The aim of this study was to evaluate the clinicopathological characteristics and long-term outcomes of mixed adenocarcinoma diagnosed as EGC after endoscopic submucosal dissection (ESD).
  
  
  METHODS
  There were 430 EGCs histologically proven by ESD in 395 patients. The clinicopathological characteristics and long-term outcomes, including the rates of local recurrence, were evaluated according to histological type in EGC treated with ESD.
  
  
  RESULTS
  In total, 430 EGCs were classified as 362 (84.4%) tubular adenocarcinomas, 41 (9.5%) poorly cohesive carcinomas (PCCs), 26 (6.0%) mixed adenocarcinomas, and 1 (0.2%) papillary adenocarcinoma according to the World Health Organization classification. Although the en bloc resection rate was acceptable (92.3%) for mixed adenocarcinoma, the complete resection rate was lower (53.8%) than those in other types (P < 0.01). Local recurrence occurred in 5 (19.2%) of 26 mixed adenocarcinomas after ESD. In a multivariate analysis, mixed adenocarcinoma was an independent risk factor predicting local recurrence after ESD for EGC (hazard ratio, 7.039; P < 0.01).
  
  
  CONCLUSIONS
  Mixed adenocarcinoma is more aggressive than other histological types of EGC based on clinical outcomes. Moreover, it is an independent prognostic factor for local recurrence after ESD for EGC.
authors.affiliation: Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Jae Pil
authors.initials: JP
authors.lastname: Han
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005544:Forecasting; D005743:Gastrectomy / Q000379:methods; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: early gastric cancer; endoscopic submucosal dissection; mixed adenocarcinoma