title: Histological mixed-type as an independent prognostic factor in stage I gastric carcinoma.
abstract: OBJECTIVE
  To evaluate the clinicopathological features of mixed-type gastric cancer and their influence on prognosis of mixed-type stage I gastric cancer.
  
  
  METHODS
  We analyzed 446 patients who underwent curative gastrectomy for stage I gastric cancer between 1999 and 2009. The patients were divided into two groups: those with differentiated or undifferentiated cancer (non-mixed-type, n = 333) and those with a mixture of differentiated and undifferentiated cancers (mixed-type, n = 113).
  
  
  RESULTS
  The overall prevalence of mixed-type gastric cancer was 25.3% (113/446). Compared with patients with non-mixed-type gastric cancer, those with mixed-type gastric cancer tended to be older at onset (P = 0.1252) and have a higher incidence of lymph node metastasis (P = 0.1476). They also had significantly larger tumors (P < 0.0001), more aggressive lymphatic invasion (P = 0.0011), and deeper tumor invasion (P < 0.0001). In addition, they exhibited significantly worse overall survival rates than did patients with non-mixed-type gastric cancer (P = 0.0026). Furthermore, mixed-type gastric cancer was independently associated with a worse outcome in multivariate analysis [P = 0.0300, hazard ratio = 11.4 (1.265-102.7)].
  
  
  CONCLUSIONS
  Histological mixed-type of gastric cancer contributes to malignant outcomes and highlight its usefulness as a prognostic indicator in stage I gastric cancer.
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Mahito
authors.initials: M
authors.lastname: Miyamae
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kishimoto
authors.affiliation: Shuhei Komatsu, Daisuke Ichikawa, Mahito Miyamae, Hiroki Shimizu, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Kazuma Okamoto, Mitsuo Kishimoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018193:Neoplasms, Complex and Mixed / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Early gastric cancer; Histological type; Mixed-type gastric cancer; Prognosis