Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2012; 18(27): 3571-3577
Published online Jul 21, 2012. doi: 10.3748/wjg.v18.i27.3571
Endoscopic and clinicopathologic characteristics of early gastric cancer with high microsatellite instability
Jaehoon Jahng, Young Hoon Youn, Kwang Hyun Kim, Junghwan Yu, Yong Chan Lee, Woo Jin Hyung, Sung Hoon Noh, Hyunki Kim, Hogeun Kim, Hyojin Park, Sang In Lee
Jaehoon Jahng, Young Hoon Youn, Kwang Hyun Kim, Junghwan Yu, Hyojin Park, Sang In Lee, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, South Korea
Yong Chan Lee, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 100-753, South Korea
Woo Jin Hyung, Sung Hoon Noh, Department of Surgery, Yonsei University College of Medicine, Seoul 100-753, South Korea
Hyunki Kim, Hoguen Kim, Department of Pathology, Yonsei University College of Medicine, Seoul 100-753, South Korea
Author contributions: Jahng J, Youn YH, Park H, Lee YC and Lee SI performed the research; Kim KH and Yu J collected and analyzed the data; Kim H, Kim H, Hyung WJ and Noh SH analyzed the data; Young YH designed the original idea; Jahng J and Youn YH wrote the paper.
Correspondence to: Young Hoon Youn, MD, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnamgu, Seoul 135-720, South Korea. dryoun@yuhs.ac
Telephone: +82-2-20193310 Fax: +82-2-34633882
Received: January 29, 2012
Revised: March 20, 2012
Accepted: April 9, 2012
Published online: July 21, 2012
Abstract

AIM: To investigate endoscopic and clinicopathologic characteristics of early gastric cancer (EGC) according to microsatellite instability phenotype.

METHODS: Data were retrospectively collected from a single tertiary referral center. Of 981 EGC patients surgically treated between December 2003 and October 2007, 73 consecutive EGC patients with two or more microsatellite instability (MSI) mutation [high MSI (MSI-H)] and 146 consecutive EGC patients with one or no MSI mutation (non-MSI-H) were selected. The endoscopic and clinicopathologic features were compared between the MSI-H and non-MSI-H EGC groups.

RESULTS: In terms of endoscopic characteristics, MSI-H EGCs more frequently presented with elevated pattern (OR 4.38, 95% CI: 2.40-8.01, P < 0.001), moderate-to-severe atrophy in the surrounding mucosa (OR 1.91, 95% CI: 1.05-3.47, P = 0.033), antral location (OR 3.99, 95% CI: 2.12-7.52, P < 0.001) and synchronous lesions, compared to non-MSI-H EGCs (OR 2.65, 95% CI: 1.16-6.07, P = 0.021). Other significant clinicopathologic characteristics of MSI-H EGC included predominance of female sex (OR 2.77, 95% CI: 1.53-4.99, P < 0.001), older age (> 70 years) (OR 3.30, 95% CI: 1.57-6.92, P = 0.002), better histologic differentiation (OR 2.35, 95% CI: 1.27-4.34, P = 0.007), intestinal type by Lauren classification (OR 2.34, 95% CI: 1.15-4.76, P = 0.019), absence of a signet ring cell component (OR 2.44, 95% CI: 1.02-5.86, P = 0.046), presence of mucinous component (OR 5.06, 95% CI: 1.27-20.17, P = 0.022), moderate-to-severe lymphoid stromal reaction (OR 3.95, 95% CI: 1.59-9.80, P = 0.003), and co-existing underlying adenoma (OR 2.66, 95% CI: 1.43-4.95, P = 0.002).

CONCLUSION: MSI-H EGC is associated with unique endoscopic and clinicopathologic characteristics including frequent presentation in protruded type, co-existing underlying adenoma, and synchronous lesions.

Keywords: Microsatellite instability; Early gastric cancer; Endoscopic characteristic; Advanced gastric cancer