Does Clear Cell Carcinoma of Stomach Exist? Clinicopathological and Prognostic Significance of Clear Cell Changes in 762 Gastric Adenocarcinomas
Ahrong Kim, Joo-yeon Kim, Nari Shin, Won-Young Park, Do Youn Park. Pusan National University Hospital, Busan, Korea
Background: Clear cell carcinoma as a variant of gastric adenocarcinoma is not well recognized in compared to that of ovary or uterine endometrium, which is a distinct subtype with poor survival.
Design: We have evaluated 762 gastric adenocarcinomas for the presence of clear cell changes of the cystoplasm and investigated its relationship with various clinicopathological features of gastric adenocarcinoma as well as the prognostic significance.
Results: We have found that 11.5% (n=88/762) of our gastric adenocarcinoma cases showed clear cell changes. Gastric adenocarcinoma with clear cell changes (clear cell proportion ≥5% of tumor mass) showed tubular (77.3%, 68/88), tubulopapillary (12.5%, 11/88), poorly solid (8.0%, 7/88) and papillary histologic features (2.3%, 2/88). Gastric adenocarcinoma with clear cell changes was significantly associated with increased age (p=0.000), larger tumor size (p=0.015), more excavated gross morphology (p=0.000), intestinal histologic type (p=0.000) and more antral location (p=0.000). Also presence of clear cell component was associated with increase of depth of invasion (p=0.000), increase of lymph node metastases (p=0.000), presence of lymphovascular tumor emboli (p=0.000) and perineural invasion (p=0.001) in the 762 gastric adenocarcinoma patients. Gastric adenocarcinomas were also associated with poor prognosis (shorter survival) based on the proportion of clear cell component (< 5%: 72.03 ± 0.90, 5-15%: 61.58 ±4.55, >15%: 56.59 ±7.62, p=0.0013). The presence of clear cell proportion was identified as an independent, poor prognostic factor using the Cox regression proportional hazard model (hazard ratio, 0.471; p = 0.001) in gastric adenocarcinoma adjusted for age, site of location, Lauren classification, depth of invasion and lymph node status.
Conclusions: We suggested that gastric adenocarcinoma with clear cell changes could be a distinct subtype of gastric adenocarcinoma with poor prognosis. More detailed and multi-institutional studies are needed to determine precise significance of clear cell changes in gastric adenocarcinoma.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 94, Wednesday Afternoon