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Prognostic Threshold of Neuroendocrine Differentiation in Gastric Carcinoma: a Clinicopathological Study of 945 Cases
Journal of Gastric Cancer ; : 121-131, 2019.
Article in En | WPRIM | ID: wpr-740304
Responsible library: WPRO
ABSTRACT
PURPOSE: The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications. MATERIALS AND METHODS: Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters. RESULTS: In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED. CONCLUSIONS: GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.
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Full text: 1 Index: WPRIM Main subject: Prognosis / Stomach / Stomach Neoplasms / Immunohistochemistry / Adenocarcinoma / Synaptophysin / Classification / Neural Cell Adhesion Molecules / Chromogranin A / Lymph Nodes Type of study: Prognostic_studies Limits: Humans Language: En Journal: Journal of Gastric Cancer Year: 2019 Type: Article
Full text: 1 Index: WPRIM Main subject: Prognosis / Stomach / Stomach Neoplasms / Immunohistochemistry / Adenocarcinoma / Synaptophysin / Classification / Neural Cell Adhesion Molecules / Chromogranin A / Lymph Nodes Type of study: Prognostic_studies Limits: Humans Language: En Journal: Journal of Gastric Cancer Year: 2019 Type: Article