title: Clinical application of early gastric carcinoma with lymphoid stroma based on lymph node metastasis status.
abstract: BACKGROUND
  Gastric carcinoma with lymphoid stroma (GCLS) is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. GCLS has unique clinicopathological features and a better prognosis compared to other types of gastric cancer. We analyzed the clinicopathological features of early GCLS in relation to lymph node metastasis (LNM).
  
  
  METHODS
  We performed a retrospective analysis of 241 patients diagnosed with GCLS confined to the mucosa or the submucosa between March 1998 and December 2015. Their data were compared with those from 1219 patients who underwent resection for differentiated early gastric cancer (EGC).
  
  
  RESULTS
  Of the 241 patients analyzed, 33 (13.7%) had intramucosal cancers and 208 (86.3%) had cancers that penetrated the submucosa. Compared to differentiated EGC, early GCLS was more prevalent in younger individuals and in men, tended to be proximally located, was highly associated with Epstein-Barr virus (EBV) infection (89.2%), and had a lower risk of LNM. The 5-year disease-specific survival rate of patients with early GCLS was 98.3% but depended significantly on LNM status (p < 0.001) and EBV infection status (p = 0.039). The risk of LNM from mucosal GCLS and submucosal GCLS was 0% [95% confidence interval (CI) 0-9.1] and 10% (95% CI 6.8-15.2), respectively. On multivariate analysis, LNM was found to be associated with tumor size (p = 0.022) and lymphovascular invasion (p = 0.002) in addition to tumor depth.
  
  
  CONCLUSIONS
  Early GCLS has distinct clinicopathological features depending on age, sex, tumor location, EBV infection status, and LNM status. Tailored therapies, including endoscopic treatment, are needed based on the distinct clinicopathological features of early GCLS.
authors.affiliation: Department of Internal Medicine, University of Hallym College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Lim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: In Seob
authors.initials: IS
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. jhlee.gi@amc.seoul.kr.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Hyo Jeong
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Hee Kyong
authors.initials: HK
authors.lastname: Na
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Kee Don
authors.initials: KD
authors.lastname: Choi
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Ho June
authors.initials: HJ
authors.lastname: Song
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Gin Hyug
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Hwoon-Yong
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Beom Su
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South 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, Seoul, South Korea.
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology*; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology*; D015996:Survival Rate
keywords: Early gastric cancer; Epstein–Barr virus; Gastric carcinoma with lymphoid stroma; Stomach