Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes
Background: The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovasc...
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MDPI AG
2024-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/5/979 |
| _version_ | 1797264698531381248 |
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| author | Bo Sun Huanhuan Li Xiaodong Gu Hong Cai |
| author_facet | Bo Sun Huanhuan Li Xiaodong Gu Hong Cai |
| author_sort | Bo Sun |
| collection | DOAJ |
| description | Background: The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. Material and methods: A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). Results: We found a strong association between LVI and LNM (<i>p</i> < 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4–8.5, <i>p</i> < 0.001) and 4.4 (95% CI: 2.1–8.9, <i>p</i> < 0.001), respectively. Conclusions: LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies. |
| first_indexed | 2024-04-25T00:33:02Z |
| format | Article |
| id | doaj.art-1db83dda5c7c41059d0aa9b946918eeb |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-04-25T00:33:02Z |
| publishDate | 2024-02-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-1db83dda5c7c41059d0aa9b946918eeb2024-03-12T16:41:04ZengMDPI AGCancers2072-66942024-02-0116597910.3390/cancers16050979Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery OutcomesBo Sun0Huanhuan Li1Xiaodong Gu2Hong Cai3Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Oncology, Shanghai Medical College of Fudan University, Shanghai 200032, ChinaDepartment of General Surgery, Huashan Hospital, Fudan University, Shanghai 200031, ChinaDepartment of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaBackground: The management of early gastric cancer (EGC) has witnessed a rise in the utilization of endoscopic submucosal dissection (ESD) as a treatment modality, although prognostic markers are needed to guide management strategies. This study investigates the prognostic implications of lymphovascular invasion (LVI) in ESD-eligible EGC patients, specifically its implications for subsequent radical surgery. Material and methods: A retrospective, multicenter study from two primary hospitals analyzed clinicopathological data from 1369 EGC patients eligible for ESD, who underwent gastrectomy at Shanghai Cancer Center and Huashan Hospital between 2009 and 2018. We evaluated the relationship between LVI and lymph node metastasis (LNM), as well as the influence of LVI on recurrence-free survival (RFS) and overall survival (OS). Results: We found a strong association between LVI and LNM (<i>p</i> < 0.001). Advanced machine learning approaches, including Random Forest, Gradient Boosting Machine, and eXtreme Gradient Boosting, confirmed the pivotal role of LVI in forecasting LNM from both centers. Multivariate analysis identified LVI as an independent negative prognostic factor for both RFS and OS, with hazard ratios of 4.5 (95% CI: 2.4–8.5, <i>p</i> < 0.001) and 4.4 (95% CI: 2.1–8.9, <i>p</i> < 0.001), respectively. Conclusions: LVI is crucial for risk stratification in ESD-eligible EGC patients, underscoring the necessity for radical gastrectomy. Future research should explore the potential incorporation of LVI status into existing TNM staging systems and novel therapeutic strategies.https://www.mdpi.com/2072-6694/16/5/979early gastric cancerendoscopic submucosal dissectionlymphovascular invasionlymph node metastasisprognostic factors |
| spellingShingle | Bo Sun Huanhuan Li Xiaodong Gu Hong Cai Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes Cancers early gastric cancer endoscopic submucosal dissection lymphovascular invasion lymph node metastasis prognostic factors |
| title | Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes |
| title_full | Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes |
| title_fullStr | Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes |
| title_full_unstemmed | Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes |
| title_short | Prognostic Implication of Lymphovascular Invasion in Early Gastric Cancer Meeting Endoscopic Submucosal Dissection Criteria: Insights from Radical Surgery Outcomes |
| title_sort | prognostic implication of lymphovascular invasion in early gastric cancer meeting endoscopic submucosal dissection criteria insights from radical surgery outcomes |
| topic | early gastric cancer endoscopic submucosal dissection lymphovascular invasion lymph node metastasis prognostic factors |
| url | https://www.mdpi.com/2072-6694/16/5/979 |
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