title: Early gastric cancer with a mixed-type Lauren classification is more aggressive and exhibits greater lymph node metastasis.
abstract: BACKGROUND
  The clinicopathological features of mixed-type (MT) early gastric cancer (EGC) according to Lauren's classification remain uninvestigated. This study aimed to clarify the clinicopathological features of MT EGC, particularly in relation to lymph node metastasis (LNM) and long-term survival.
  
  
  METHODS
  This study included 5309 patients who underwent gastrectomy for EGC. The clinicopathological features, LNM, and long-term outcomes of patients with MT carcinomas were compared with those of patients with intestinal-type (IT) and diffuse-type (DT) cancers. Furthermore, we evaluated the predictors of LNM in each Lauren classification subgroup.
  
  
  RESULTS
  Patients with MT carcinomas were likelier to have larger tumors, submucosal invasion, lymphovascular invasion, and LNM than those with IT or DT carcinomas. Multivariate logistic regression analysis revealed that the Lauren classification was a significant predictor of LNM (P < 0.001). The significant predictors of LNM in MT carcinomas were female sex, greater tumor size, presence of submucosal invasion, and lymphovascular invasion. However, the overall survival of patients with MT carcinoma was not significantly different from that of patients with IT or DT carcinomas (P = 0.104).
  
  
  CONCLUSIONS
  The presence of MT EGC carries a higher risk of LNM compared with the presence of IT or DT carcinomas. Therefore, MT carcinomas should be managed with gastrectomy that includes lymph node dissection instead of endoscopic resection.
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Jeung Hui
authors: JH
authors: Pyo
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Hyuk
authors: H
authors: Lee
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Byung-Hoon
authors: BH
authors: Min
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Jun Haeng
authors: JH
authors: Lee
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors: Min Gew
authors: MG
authors: Choi
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. junho87.lee@samsung.com.
authors: Jun Ho
authors: JH
authors: Lee
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors: Tae Sung
authors: TS
authors: Sohn
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors: Jae Moon
authors: JM
authors: Bae
authors: Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. km7353.kim@samsung.com.
authors: Kyoung-Mee
authors: KM
authors: Kim
authors: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Seungmin
authors: S
authors: Yeon
authors: Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
authors: Sin-Ho
authors: SH
authors: Jung
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Jae J
authors: JJ
authors: Kim
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors: Sung
authors: S
authors: Kim
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
keywords: Early gastric cancer; Lauren’s classification; Lymph node metastasis; Mixed type