J Cancer 2017; 8(1):117-123. doi:10.7150/jca.17326

Research Paper

Worse Prognosis in Papillary, Compared to Tubular, Early Gastric Carcinoma

Huiping Yu1*, Cheng Fang1,2,4*, Lin Chen1, Jiong Shi1, Xianshan Fan1, Xiaoping Zou2, Qin Huang1,2,3✉

1. Department of Pathology, Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, P.R.China.
2. Department of Gastroenterology, Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, P.R.China.
3. Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA 02132, U.S.A.
4. The current affiliation: Department of Gastroenterology, Zhejiang University affiliated Second Hospital, Hangzhou, China.
* These Authors are co-first authors.

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Yu H, Fang C, Chen L, Shi J, Fan X, Zou X, Huang Q. Worse Prognosis in Papillary, Compared to Tubular, Early Gastric Carcinoma. J Cancer 2017; 8(1):117-123. doi:10.7150/jca.17326. Available from http://www.jcancer.org/v08p0117.htm

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Purpose: Papillary early gastric carcinoma (EGC) is uncommon but shows worse prognosis in our most recent study in a Chinese population with unknown reasons. The aim of the present study was to further investigate risk factors for worse prognosis in patients with papillary adenocarcinoma, compared to those with tubular adenocarcinoma.

Methods: We searched the electronic pathology databank for radical gastrectomy cases over an 8-year period at a single medical center in Nanjing, China, and identified consecutive 240 EGC cases that were classified as either papillary (n=59) or tubular (n=181) EGC tumors in accordance with the World Health Organization (WHO) gastric cancer diagnosis criteria. We investigated and compared clinicopathologic risk factors for prognosis between papillary and tubular EGC groups. All patients were followed up and their 5-year survival rate was compared statistically with the Kaplan-Meier method with a log rank test.

Results: Compared to tubular EGCs, papillary EGCs were significantly more common in elderly patients, more frequently occurred in the proximal stomach with protruding/elevated growth patterns, submucosal invasion, and a micropapillary component. Although lymphovascular invasion (16.9%), nodal (13.6%) and distant (11.8%) metastases in papillary EGCs were more frequent than those (8.3%, 7.2%, and 3.7%, respectively) in tubular EGCs, the differences approached but did not reach statistically significant levels. Significant risk factors for nodal metastasis included lymphovascular invasion in both EGC groups, but the ulcerative pattern and submucosal invasion only in tubular EGCs. The 5-year survival rate was significantly worse in papillary (80.5%) than in tubular (96.8%) EGCs.

Conclusions: Compared to tubular EGCs, papillary EGCs diagnosed with the WHO criteria in Chinese patients were more frequent in elderly patients, proximal stomach and showed the significantly worse 5-year survival rate with more protruding/elevated growth patterns and the micropapillary component. Further studies in larger samples are urgently needed to validate these findings for precision individualized EGC patient management.

Keywords: stomach, early gastric carcinoma, papillary, prognosis, nodal metastasis.