Low risk of lymph node metastasis in 495 early gastric cardiac carcinomas: a multicenter clinicopathologic study of 2101 radical gastrectomies for early gastric carcinoma.

Clinical decision-making on endoscopic vs. surgical resection of early gastric cardiac carcinoma remains challenging because of uncertainty on risk of lymph node metastasis. The aim of this multicenter study was to investigate risk factors of lymph node metastasis in early gastric cardiac carcinoma. Guided with the World Health Organization diagnostic criteria, we studied 2101 radical resections of early gastric carcinoma for risk factors associated with lymph node metastasis, including tumor location, gross pattern, size, histology type, differentiation, invasion depth, lymphovascular, and perineural invasion. We found that the risk of lymph node metastasis was significantly lower in early gastric cardiac carcinomas (6.7%, 33/495), compared with early gastric non-cardiac carcinomas (17.1%, 275/1606) (p < 0.0001). In early gastric cardiac carcinoma, no lymph node metastasis was identified in intramucosal carcinoma (0/193) and uncommon types of carcinomas (0/24), irrespective of the gross pattern, size, histologic type, differentiation, and invasion depth. Ulceration, size > 3 cm, and submucosal invasion were not significant independent risk factors for lymph node metastasis. In 33 early gastric cardiac carcinomas with lymph node metastasis, either lymphovascular invasion or poor differentiation was present in 16 (48.5%) cases and together in six cases. By multivariate analysis, independent risk factors of lymph node metastasis in early gastric cardiac carcinoma included lymphovascular invasion (Odds Ratio (OR): 7.6, 95% Confidence Interval (CI): 2.8-20.2) (p < 0.0001) and poor differentiation (OR: 6.0, 95% CI: 1.4-25.9) (p < 0.05). In conclusion, lymph node metastasis was not identified in early gastric cardiac intramucosal carcinoma and uncommon types of carcinoma. The risk of lymph node metastasis was also significantly lower in tumors with submucosal invasion, especially for cases without lymphovascular invasion or poor differentiation. These results lend support to the role of endoscopic therapy in the treatment of patients with early gastric cardiac carcinoma.

Plain and Gd-EOB-DTPA enhanced MRI for differentiating clear cell and non-otherwise specified hepatocellular carcinoma / 中国医学影像技术

Objective To investigate the value of plain and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for differentiating clear cell hepatocellular carcinoma(CCHCC)and non-otherwise specified hepatocellular carcinoma(NOS-HCC).Methods Totally 36 CCHCC(CCHCC group)patients and 72 age-matched NOS-HCC(NOS-HCC group)patients were enrolled.Univariate analysis and multivariate logistic regression were used to retrospectively analyze the clinical,pathological and plain upper abdominal MRI as well as Gd-EOB-DTPA enhanced MRI data,so as to screen the independent predictors for distinguishing CCHCC and NOS-HCC.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of MRI-related independent predictors for distinguishing CCHCC and NOS-HCC individually and in combination.Results Pathologic Edmondson-Steiner grade of HCC,lesions with fat components showed on MRI,the ratio of lesion-to-liver signal intensity on plain T1WI(LLRT1WI)and the ratio of lesion-to-muscle signal intensity on plain T1WI(LMRT1WI)were all independent predictors for distinguishing CCHCC from NOS-HCC(all P＜0.05).The AUC of lesions with fat components,LLRT1WI and LMRT1WI for distinguishing CCHCC and NOS-HCC alone was 0.652,0.689 and 0.687,respectively,and of the combination was 0.762,higher than that of lesions with fat components(Z=-2.401,P=0.016)but not different with AUC of LLRT1WI(Z=-1.841,P=0.066)and LMRT1WI(Z=-1.440,P=0.150)alone.Conclusion Plain and Gd-EOB-DTPA enhanced MRI could be used to distinguish CCHCC and NOS-HCC.