Lesion size, elevated morphology, and non or closed-type atrophy are predictive factors for gastric adenocarcinoma of the fundic gland type rather than oxyntic gland adenoma

Masaya Iwamuro; Chiaki Kusumoto; Masahiro Nakagawa; Kazuhiro Matsueda; Sayo Kobayashi; Masao Yoshioka; Tomoki Inaba; Tatsuya Toyokawa; Chihiro Sakaguchi; Shouichi Tanaka; Takehiro Tanaka; Hiroyuki Okada

doi:10.21037/jgo-22-870

Lesion size, elevated morphology, and non or closed-type atrophy are predictive factors for gastric adenocarcinoma of the fundic gland type rather than oxyntic gland adenoma

J Gastrointest Oncol. 2023 Apr 29;14(2):554-562. doi: 10.21037/jgo-22-870. Epub 2023 Mar 16.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan.
² Department of Gastroenterology, Nippon Kokan Fukuyama Hospital, Fukuyama, Hiroshima, Japan.
³ Department of Endoscopy, Hiroshima City Hospital, Hiroshima, Hiroshima, Japan.
⁴ Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
⁵ Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
⁶ Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Okayama, Japan.
⁷ Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.
⁸ Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Hiroshima, Japan.
⁹ Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan.
¹⁰ Department of Gastroenterology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan.
¹¹ Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan.

Abstract

Background: An oxyntic gland neoplasm confined to the mucosal layer (T1a) is classified as an oxyntic gland adenoma, whereas that with submucosal invasion (T1b) is defined as gastric adenocarcinoma of the fundic gland type (GA-FG).

Methods: To reveal the differences in clinical features between them, we retrospectively investigated 136 patients with 150 oxyntic gland adenoma and GA-FG lesions.

Results: The univariate analysis revealed that the mean size (GA-FG vs. oxyntic gland adenoma, 7.7±5.4 vs. 5.5±3.1 mm), the prevalence of elevated morphology (79.1% vs. 51.8%), black pigmentation within the lesion (23.9% vs. 9.6%), and non or closed-type atrophy (81.2% vs. 65.1%) were different between the two groups. A multivariate logistic regression analysis revealed that ≥5 mm lesion size (odds ratio, 2.96; 95% confidence interval: 1.21-7.23), elevated morphology (odds ratio, 2.40; 95% confidence interval: 1.06-5.45), and no or closed-type atrophy (odds ratio, 2.49; 95% confidence interval: 1.07-5.80) were factors in distinguishing GA-FG from oxyntic gland adenoma. When oxyntic gland neoplasms with no or one feature were judged as oxyntic gland adenomas and those with two or three features were judged as GA-FG, the sensitivity and specificity were 85.1% and 43.4% for GA-FG, respectively.

Conclusions: We identified three possible distinctive features of GA-FG compared to oxyntic gland adenoma: lesion size ≥5 mm, elevated morphology, and no or closed-type atrophy.

Keywords: Gastric adenocarcinoma of the fundic gland type (GA-FG); gastric neoplasms; oxyntic gland adenoma; submucosal invasion.