Brief Article
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World J Gastroenterol. Sep 7, 2012; 18(33): 4578-4584
Published online Sep 7, 2012. doi: 10.3748/wjg.v18.i33.4578
Does immunohistochemical staining have a clinical impact in early gastric cancer conducted endoscopic submucosal dissection?
Seong Ran Jeon, Joo Young Cho, Gene Hyun Bok, Tae Hee Lee, Hyun Gun Kim, Won Young Cho, So Young Jin, Yeon Soo Kim
Seong Ran Jeon, Joo Young Cho, Gene Hyun Bok, Tae Hee Lee, Hyun Gun Kim, Won Young Cho, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul 140-743, South Korea
So Young Jin, Department of Pathology, Soonchunhyang University College of Medicine, Seoul 140-743, South Korea
Yeon Soo Kim, Department of Internal Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Daejeon 301-723, South Korea
Author contributions: Jeon SR drafted the article, analysis and interpreted of the data; Bok GH, Lee TH, Kim HG, Cho WY, and Kim YS were responsible for analysis and interpretation of the data; Jin SY reviewed data analysis and corrected research design; Cho JY made the critical revision of the article for important intellectual content and final approval of the article.
Correspondence to: Joo Young Cho, Professor, MD, PhD, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, 657 Hannam-Dong, Yongsan-Gu, Seoul 140-743, South Korea. cjy6695@dreamwiz.com
Telephone: + 82-2-7099202 Fax: +82-2-7099696
Received: January 9, 2012
Revised: April 6, 2012
Accepted: April 12, 2012
Published online: September 7, 2012
Abstract

AIM: To evaluate clinicopathologic parameters and the clinical significance related lymphovascular invasion (LVI) by immunohistochemical staining (IHCS) in endoscopic submucosal dissection (ESD).

METHODS: Between May 2005 and May 2010, a total of 348 lesions from 321 patients (mean age 63 ± 10 years, men 74.6%) with early gastric cancer (EGC) who met indication criteria after ESD were analyzed retrospectively. The 348 lesions were divided into the absolute (n = 100, differentiated mucosal cancer without ulcer ≤ 20 mm) and expanded (n = 248) indication groups after ESD. The 248 lesions were divided into four subgroups according to the expanded ESD indication. The presence of LVI was determined by factor VIII-related antigen and D2-40 assessment. We compared LVI IHCS-negative group with LVI IHCS-positive in each group.

RESULTS: LVI by hematoxylin-eosin staining (HES) and IHCS were all negative in the absolute group, while was observed in only the expanded groups. The positive rate of LVI by IHCS was higher than that of LVI by HES (n = 1, 0.4% vs n = 11, 4.4%, P = 0.044). LVI IHCS-positivity was observed when the cancer invaded to the mucosa 3 (M3) or submucosa 1 (SM1) levels, with a predominance of 63.6% in the subgroup that included only SM1 cancer (P < 0.01). In a univariate analysis, M3 or SM1 invasion by the tumor was significantly associated with a higher rate of LVI by IHCS, but no factor was significant in a multivariate analysis. There were no cases of tumor recurrence or metastasis during the median 26 mo follow-up.

CONCLUSION: EGCs of the absolute group are immunohistochemically stable. The presence of LVI may be carefully examined by IHCS in an ESD expanded indication group with an invasion depth of M3 or greater.

Keywords: Gastric cancer; Endoscopic submucosal dissection; Immunohistochemical staining; Lymphovascular invasion; Depth