title: Malignant Potential of Gastrointestinal Cancers Assessed by Structural Equation Modeling.
abstract: BACKGROUND
  Parameters reported in pathologic reviews have been failing to assess exactly the malignant potential of gastrointestinal cancers. We hypothesized that malignant potential could be defined by common latent variables (hypothesis I), but there are substantial differences in the associations between malignant potential and pathologic parameters according to the origin of gastrointestinal cancers (hypothesis II). We shed light on these issues by structural equation modeling.
  
  
  METHODS
  We conducted a cross-sectional survey of 217 esophageal, 192 gastric, and 175 colorectal cancer patients who consecutively underwent curative surgery for their pathologic stage I cancers at Keiyukai Sapporo Hospital. Latent variables identified by factor analysis and seven conventional pathologic parameters were introduced in the structural equation modeling analysis.
  
  
  RESULTS
  Because latent variables were disparate except for their number, 'three' in the examined gastrointestinal cancers, the first hypothesis was rejected. Because configural invariance across gastrointestinal cancers was not approved, the second hypothesis was verified. We could trace the three significant paths on the causal graph from latent variables to lymph node metastasis, which were mediated through depth, lymphatic invasion, and matrilysin expression in esophageal cancer, whereas only one significant path could be traced in both gastric and colorectal cancer. Two of the three latent variables were exogenous in esophageal cancer, whereas one factor was exogenous in the other gastrointestinal cancers. Cancer stemness promoted viability in esophageal cancer, but it was suppressed in others.
  
  
  CONCLUSIONS
  These results reflect the malignant potential of esophageal cancer is higher than that of the other gastrointestinal cancers. Such information might contribute to refining clinical treatments for gastrointestinal cancers.
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Arimura
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Onodera
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okahara
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Kodaira
authors.affiliation: Department of Gastroenterology, Keiyukai Daini Hospital, Sapporo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Oohashi
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isshiki
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kawakami
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Shinomura
authors.affiliation: Department of Surgery, Keiyukai Hospital, Sapporo, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Hosokawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D060787:Neoplasm Grading; D009367:Neoplasm Staging