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J Gastric Cancer. 2019 Mar;19(1):121-131. doi: 10.5230/jgc.2019.19.e9. Epub 2019 Mar 20.

Prognostic Threshold of Neuroendocrine Differentiation in Gastric Carcinoma: a Clinicopathological Study of 945 Cases.

Author information

1
Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
2
Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
3
Public Security Bureau of Changle City, Changle, China.
4
Department of Pathology, No. 2 Hospital, Xiamen, China.
5
Department of Pathology, Fujian Provincial Cancer Hospital, Fuzhou, China.
6
Maternity and Child Care Hospital of Huli District, Xiamen, China.

Abstract

Purpose:

The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications.

Materials and Methods:

Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters.

Results:

In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED.

Conclusions:

GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.

KEYWORDS:

Adenocarcinoma; Immunohistochemistry; Neuroendocine tumors; Prognosis; Stomach neoplasms

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

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