CLINICAL AND PROGNOSTIC CHARACTERISTICS OF PAPILLARY CLEAR CARCINOMA OF STOMACH

Papillary clear carcinoma (PCC), a variant of gastric papillary adenoc arcinoma, demonstrates the histologic features of cancer cells with cl ear cytoplasm and no nuclear polarity, resembling the primitive gut ep ithelium of the fetus, To clarify the clinical and prognostic characte ristics of PCC, we examined operative specimens from 73 patients with gastric papillary adenocarcinoma. Light microscopic examination of hem atoxylin and eosin (H&E) stained sections of specimens from 15 patient s revealed the features of PCC. The patients with PCC demonstrated a h igher incidence of Type 3 gross appearance, tumor invasion into the mu scularis propria or beyond, involvement of distal lymph nodes, liver m etastasis, elevated serum AFP concentrations, and palliative resection s. In two subsets of patients who underwent curative resections of tum ors invading the muscularis propria or beyond, those with PCC were fou nd to have a significantly lower survival rate than those,vith other t ypes of papillary adenocarcinoma (P < 0.05). PCC histology was a signi ficant prognostic determinant according to multivariate analysis with the Cox proportional hazards model. We conclude that this subclassific ation of papillary adenocarcinoma, based on the cellular findings, is a useful prognostic indicator, and that intensive adjuvant therapy may be indicated for patients with the features of PCC, even if they have undergone curative resections.