Clinical characteristics and prognostic factors of differentiated and undifferentiated early gastric cancer: A retrospective cohort study

Early gastric cancer (EGC) exhibits variable clinical behavior depending on histological differentiation. Understanding these differences is crucial for accurate diagnosis and personalized treatment planning. This study aimed to investigate the clinical characteristics associated with different differentiation types in EGC and evaluate their prognostic significance. A retrospective cohort study was conducted on 152 EGC patients treated between January 2023 and December 2024. Patients were categorized into differentiated (n = 80) and undifferentiated (n = 72) groups. Demographic and clinical data - including age, sex, tumor characteristics, endoscopic findings, and pathological features - were compared. Statistical analyses included chi-square and t-tests, multivariate logistic regression, and receiver operating characteristic curve analysis to identify and evaluate predictors of undifferentiated EGC. Patients with undifferentiated EGC were significantly younger than those with differentiated EGC (55.27 ± 11.15 vs 64.38 ± 10.56 years, P < .001). The undifferentiated group showed higher frequencies of abdominal bloating/pain, weight loss, and detection during asymptomatic physical examinations (all P < .05). Endoscopic and pathological features such as white lesion coloration, submucosal invasion, ulceration, vascular invasion, and lymph node metastasis were more common in undifferentiated cases. Multivariate analysis identified age, lesion color, depth of invasion, ulcer presence, vascular invasion, and lymph node metastasis as independent predictors. Receiver operating characteristic curves showed moderate diagnostic performance (area under the curve (AUC): 0.677-0.700). Undifferentiated EGC is associated with younger age and more aggressive clinical and pathological features. These findings highlight the importance of identifying key predictive factors to improve early diagnosis and guide individualized treatment strategies in EGC management.