Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer
Background: Despite the risk of lymph node metastasis (LNM), the indications of endoscopic submucosal dissection (ESD) has expanded to undifferentiated type (UD-type) early gastric cancer (EGC). There is debate as to whether the endoscopic resection can be used. This study was conducted to evaluate...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-10-01
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| Series: | Asian Journal of Surgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1015958419308826 |
| _version_ | 1818512552564359168 |
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| author | Xiao-Qin Liang Zhuo Wang Hong-Tao Li Gui Ma Wen-Wen Yu Hai-Cun Zhou Hong-Bin Liu |
| author_facet | Xiao-Qin Liang Zhuo Wang Hong-Tao Li Gui Ma Wen-Wen Yu Hai-Cun Zhou Hong-Bin Liu |
| author_sort | Xiao-Qin Liang |
| collection | DOAJ |
| description | Background: Despite the risk of lymph node metastasis (LNM), the indications of endoscopic submucosal dissection (ESD) has expanded to undifferentiated type (UD-type) early gastric cancer (EGC). There is debate as to whether the endoscopic resection can be used. This study was conducted to evaluate risk factors for LNM in undifferentiated early gastric cancer, implications for the indication of the ESD so as to providing evidence for proper clinical management for UD-type EGC. Method: We retrospectively analyzed 203 patients with UD-type EGC who underwent gastrectomy for primary gastric adenocarcinoma between 2012 and 2017. We evaluated the relationship between the clinicopathological factors and the presence of LNM using univariable and multivariable logistic regression analyses. Results: A total of 203 UD-type EGC patients were enrolled, and LNM was positive in 40 cases (19.7%). Multivariable logistic regression analysis identified three independent risk factors for LNM, the tumor size (≥2.0 cm, P < 0.001), depth of invasion (P < 0.001), and lymphatic vessel involvement (LVI, P < 0.001). LNM was observed in 5.9% patients without the three predictive factors in UD-type EGC, whereas 7.7% and 37.7% of patients with one and two risk factors had LNM, respectively. In contrast, the LNM rate was up to be 66.7% in patients with three factors. Of 41 patients satisfying the expanded indication of ESD, 3 patients (7.3%) showed LNM. LNM was not found in any of 12 patients with small intramucosal lesions (<1.0 cm) without LVI. Conclusions: LNM-related risk factors were tumor larger than 2.0 cm, submucosal invasion, and the presence of LVI in UD-type EGC. ESD alone may be sufficient treatment for the intramucosal UD-type EGC that is smaller than 1.0 cm in size. When endoscopically resected specimens show unexpectedly larger tumor size, unexpected submucosal and LVI than that determined at pre-ESD endoscopic diagnosis, an additional gastrectomy with lymphadenectomy should be considered. |
| first_indexed | 2024-12-10T23:48:27Z |
| format | Article |
| id | doaj.art-b90c4749f7b14ba387befd800e08d922 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-12-10T23:48:27Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-b90c4749f7b14ba387befd800e08d9222022-12-22T01:28:51ZengElsevierAsian Journal of Surgery1015-95842020-10-014310973977Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancerXiao-Qin Liang0Zhuo Wang1Hong-Tao Li2Gui Ma3Wen-Wen Yu4Hai-Cun Zhou5Hong-Bin Liu6Second Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu Province, China; Department of Pathology, Gansu Province People's Hospital, Lanzhou, 730000, Gansu Province, ChinaDepartment of Pathology, Gansu Province People's Hospital, Lanzhou, 730000, Gansu Province, ChinaDepartment of General Surgery, The 940th of Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, 730050, Gansu Province, ChinaDepartment of Pathology, Gansu Provincial Cancer Hospital, Lanzhou, 730050, Gansu Province, ChinaSecond Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu Province, ChinaSecond Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu Province, ChinaSecond Clinical Medical College, Lanzhou University, Lanzhou, 730030, Gansu Province, China; Department of General Surgery, The 940th of Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, 730050, Gansu Province, China; Corresponding author. Second Clinical Medical College, Lanzhou University, No. 82 Chuiying Gate, Chengguan District, Lanzhou, 730030, Gansu Province, China.Background: Despite the risk of lymph node metastasis (LNM), the indications of endoscopic submucosal dissection (ESD) has expanded to undifferentiated type (UD-type) early gastric cancer (EGC). There is debate as to whether the endoscopic resection can be used. This study was conducted to evaluate risk factors for LNM in undifferentiated early gastric cancer, implications for the indication of the ESD so as to providing evidence for proper clinical management for UD-type EGC. Method: We retrospectively analyzed 203 patients with UD-type EGC who underwent gastrectomy for primary gastric adenocarcinoma between 2012 and 2017. We evaluated the relationship between the clinicopathological factors and the presence of LNM using univariable and multivariable logistic regression analyses. Results: A total of 203 UD-type EGC patients were enrolled, and LNM was positive in 40 cases (19.7%). Multivariable logistic regression analysis identified three independent risk factors for LNM, the tumor size (≥2.0 cm, P < 0.001), depth of invasion (P < 0.001), and lymphatic vessel involvement (LVI, P < 0.001). LNM was observed in 5.9% patients without the three predictive factors in UD-type EGC, whereas 7.7% and 37.7% of patients with one and two risk factors had LNM, respectively. In contrast, the LNM rate was up to be 66.7% in patients with three factors. Of 41 patients satisfying the expanded indication of ESD, 3 patients (7.3%) showed LNM. LNM was not found in any of 12 patients with small intramucosal lesions (<1.0 cm) without LVI. Conclusions: LNM-related risk factors were tumor larger than 2.0 cm, submucosal invasion, and the presence of LVI in UD-type EGC. ESD alone may be sufficient treatment for the intramucosal UD-type EGC that is smaller than 1.0 cm in size. When endoscopically resected specimens show unexpectedly larger tumor size, unexpected submucosal and LVI than that determined at pre-ESD endoscopic diagnosis, an additional gastrectomy with lymphadenectomy should be considered.http://www.sciencedirect.com/science/article/pii/S1015958419308826Early gastric cancerEndoscopic submucosal dissectionLymph node metastasis |
| spellingShingle | Xiao-Qin Liang Zhuo Wang Hong-Tao Li Gui Ma Wen-Wen Yu Hai-Cun Zhou Hong-Bin Liu Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer Asian Journal of Surgery Early gastric cancer Endoscopic submucosal dissection Lymph node metastasis |
| title | Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| title_full | Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| title_fullStr | Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| title_full_unstemmed | Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| title_short | Indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| title_sort | indication for endoscopic treatment based on the risk of lymph node metastasis in patients with undifferentiated early gastric cancer |
| topic | Early gastric cancer Endoscopic submucosal dissection Lymph node metastasis |
| url | http://www.sciencedirect.com/science/article/pii/S1015958419308826 |
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