Does immunohistochemical staining have a clinical impact in early gastric cancer conducted endoscopic submucosal dissection?

doi:10.3748/wjg.v18.i33.4578

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Sep 7, 2012 (publication date) through Dec 25, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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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

Table 1 Endoscopic and pathologic characteristics of endoscopic submucosal dissection groups

Groups	Absolute (n = 100)	Expanded (n = 248)	P value
Age (yr), mean (range)	62.2 (33-86)	62.9 (33-91)	0.589
Male (%)	70 (70)	189 (76.2)	0.277
Location (%)			0.183
Upper	3 (3)	21 (8.5)
Middle	31 (31)	69 (27.8)
Lower	66 (66)	158 (63.7)
Macroscopic type (%)			< 0.001
Elevated	59 (59)	56 (22.6)
Flat/depressed	36 (36)	131 (52.8)
Mixed	5 (5)	61 (24.6)
Endoscopic ulcer (%)			< 0.001
Present	0 (0)	161 (64.9)
Absent	100 (100)	87 (35.1)
Resection (%)			0.053
En-bloc	100 (100)	234 (94.4)
Complete reconstruction	0 (0)	8 (3.2)
≥ 3 piecemeal	0 (0)	6 (2.4)
Histology (%)			0.069
Differentiated	100 (100)	238 (96)
Undifferentiated	0 (0)	10 (4)
Depth (%)			< 0.001
M2	59 (59)	89 (35.9)
M3	41 (41)	131 (52.8)
SM1	0 (0)	28 (11.3)
Tumor size (mean, range)	11.4 (2-20)	21.2 (3-86)	< 0.001
≤ 20 mm (%)	100 (100)	131 (52.8)
> 20 mm (%)	0 (0)	117 (47.2)
Lateral margin (%)			< 0.001
Positive	0 (0)	24 (9.7)
Negative	100 (100)	224 (90.3)
Vertical margin (%)			0.500
Positive	0 (0)	2 (0.8)
Negative	100 (100)	246 (99.2)
Phenotype (%)			0.312
Gastric	24 (24)	66 (26.6)
Intestinal	31 (31)	92 (37)
Mixed	45 (45)	90 (36.3)
VEGF (%)			0.096
Positive	79 (79)	72 (29)
Negative	21 (21)	176 (71)
High MVD/LVD (%)			0.116
Positive	16 (16)	59 (23.8)
Negative	84 (84)	189 (76.2)
LVI HES			0.713
Positive	0 (0)	1 (0.4)
Negative	100 (100)	247 (99.6)
LVI IHCS			0.038
Positive	0 (0)	11 (4.4)
Negative	100 (100)	237 (95.6)

M: Mucosa; SM: Submucosa; VEGF: Vascular endothelial growth factor; MVD: Microvessel density; LVD: Lymphatic vessel density; LVI: Lymphovascular invasion; HES: Hematoxylin-eosin staining; IHCS: Immunohistochemical staining.

Table 2 Subgroup analysis in the expanded indication groups

	Group 1 (n = 71)	Group 2 (n = 140)	Group 3 (n = 27)	Group 4 (n = 10)	P value
Age > 60 (yr, %)	44 (62)	82 (58.6)	21 (77.8)	6 (60)	0.502
Male (%)	56 (78.9)	104 (74.3)	24 (88.9)	5 (50)	0.455
Location (%)					0.730
Upper + corpus	19 (26.8)	15 (10.7)	11 (40.7)	1 (10)
Lower + angle	52 (73.2)	125 (89.3)	16 (59.3)	9 (90)
Macroscopic type (%)					< 0.001
Elevated	45 (63.4)	4 (2.9)	4 (14.8)	3 (30)
Flat/depressed	26 (36.6)	136 (97.1)	23 (85.2)	7 (70)
Endoscopic ulcer (%)					< 0.001
Present	0 (0)	140 (100)	20 (74.1)	1 (10)
Absent	71 (100)	0 (0)	7 (25.9)	9 (90)
Resection, piece (%)					0.177
≤ 2	68 (95.8)	137 (97.9)	27 (100)	10 (100)
≥ 3	3 (4.2)	3 (2.1)	0 (0)	0 (0)
Depth (%)					0.003
M2	33 (46.5)	52 (37.1)	0 (0)	4 (40)
M3 + SM1	38 (53.5)	88 (62.9)	27 (100)	6 (60)
Tumor size, mm (%)					< 0.001
≤ 20	0 (0)	105 (75)	16 (59.3)	10 (100)
> 20	71(100)	35 (25)	11 (40.7)	0 (0)
Lateral margin (%)					0.091
Positive	10 (14.1)	11 (7.9)	1 (3.7)	2 (20)
Negative	61 (85.9)	129 (92.1)	26 (96.3)	8 (80)
Vertical margin (%)					0.170
Positive	2 (2.8)	0 (0)	0 (0)	0 (0)
Negative	69 (97.2)	140 (100)	27 (100)	10 (100)
Phenotype (%)					0.107
Intestinal	31 (43.7)	50 (35.7)	9 (33.3)	2 (20)
Non-intestinal	40 (56.3)	90 (64.3)	18 (66.7)	8 (80)
VEGF (%)					0.003
Positive	17 (23.9)	34 (24.3)	16 (59.3)	5 (50)
Negative	54 (76.1)	106 (75.7)	11 (40.7)	5 (50)
High LVD/MVD (%)					< 0.001
Positive	11 (15.5)	26 (18.6)	16 (59.3)	6 (60)
Negative	60 (84.5)	114 (81.4)	11 (40.7)	4 (40)
LVI HES					0.005
Positive	0 (0)	0 (0)	0 (0)	1 (10)
Negative	71 (100)	140 (100)	27 (100)	9 (90)
LVI IHCS					< 0.001
Positive	1 (1.4)	1 (0.7)	7 (25.9)	2 (20)
Negative	70 (98.6)	139 (99.3)	20 (74.1)	8 (80)

Table 3 Comparison of lymphovascular invasion hematoxylin-eosin staining and lymphovascular invasion immunohistochemical staining groups

ESD indication			LVI IHCS		Total	P value
ESD indication			Negative	Positive		P value
Absolute	LVI HES	Negative	100	0	Total	100
Absolute	LVI HES	Positive	0	0	0
	Total		100	0	100
Expanded	LVI HES	Negative	237	10	247	0.044
Expanded	LVI HES	Positive	0	1	1 (0.4%)
	Total		237	11 (4.4%)	248

ESD: Endoscopic submucosal dissection; LVI: Lymphovascular invasion; HES: Hematoxylin-eosin staining; IHCS: Immunohistochemical staining.

Table 4 Comparison of lymphovascular invasion by immunohistochemical stain negative and positive group

	LVI IHCS		P value
	Negative (n = 237)	Positive (n = 11)
Age, yr (%)	62.6 ± 9.9	69.4 ± 10.2	P value	0.054
≤ 60	92 (38.8)	3 (27.3)
> 60	145 (61.2)	8 (72.7)
Male (%)	182 (76.8)	7 (63.6)	0.297
Location (%)			0.667
Upper + corpus	44 (18.6)	2 (18.2)
Lower + angle	193 (81.4)	9 (81.8)
Macroscopic type (%)			0.715
Elevated	53 (22.4)	3 (27.3)
Flat/depressed	184 (77.6)	8 (72.7)
Endoscopic ulcer (%)			0.524
Present	155 (65.4)	6 (54.5)
Absent	82 (34.6)	5 (45.5)
Resection, piece (%)			0.760
≤ 2	231 (97.5)	11 (100)
≥ 3	6 (2.5)	0 (0.0)
Histology (%)			0.066
Differentiated	229 (96.6)	9 (81.8)
Undifferentiated	8 (3.4)	2 (18.2)
Depth (%)			0.009
M2	89 (37.6)	0 (0)
M3 + SM1	148 (62.4)	11 (100)
Tumor size, mm (%)	21.2 ± 12.8	21.2 ± 16.7	0.986
≤ 20	125 (52.7)	6 (54.5)
> 20	112 (47.3)	5 (45.5)
Lateral margin (%)			0.289
Positive	22 (9.3)	2 (18.2)
Negative	215 (90.7)	9 (81.8)
Vertical margin (%)			0.913
Positive	2 (0.8)	0 (0)
Negative	235 (99.2)	11 (100)
Phenotype (%)			0.751
Intestinal	89 (37.6)	3 (27.3)
Non-intestinal	148 (62.4)	8 (72.7)
VEGF (%)			< 0.001
Positive	62 (26.2)	10 (90.9)
Negative	175 (73.8)	1 (9.1)
High LVD/MVD (%)			< 0.001
Positive	48 (20.3)	11 (100)
Negative	189 (79.7)	0 (0.0)

IHCS: Immunohistochemical staining; M: Mucosa; SM: Submucosa; VEGF: Vascular endothelial growth factor; LVD: Lymphatic vessel density, MVD: Microvessel density.

Table 5 Clinicopathological characteristics of the five patients who underwent surgical resection after endoscopic submucosal dissection

Sex/age (yr)	Type	Site	Ulcer	Pathology	Size (mm)	LM/VM	Depth	LVI HES	LVI IHCS	Residual tumor	LN
Female/67	IIc	Lower	-	MD	30	-/+	M	-	-	+	-
Male/74	III	Middle	+	WD	14	+/-	M	+	+	-	-
Female/64	III	Middle	+	MD	19	+/-	M	-	-	-	-
Female/54	I	Middle	-	MD	68	+/-	M	-	+	+	-
Male/35	I	Middle	-	MD	22	-/-	M	-	-	-	-

LM: Lateral margin; VM: Vertical margin; LVI: Lymphovascular invasion; HES: Hematoxylin-eosin staining; IHCS: Immunohistochemical staining; LN: Lymph node; MD: Moderately differentiated; WD: Well differentiated; M: Mucosa.

Citation: Jeon SR, Cho JY, Bok GH, Lee TH, Kim HG, Cho WY, Jin SY, Kim YS. Does immunohistochemical staining have a clinical impact in early gastric cancer conducted endoscopic submucosal dissection? World J Gastroenterol 2012; 18(33): 4578-4584
URL: https://www.wjgnet.com/1007-9327/full/v18/i33/4578.htm
DOI: https://dx.doi.org/10.3748/wjg.v18.i33.4578