Cargando…

Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer

BACKGROUND: When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. PATIENTS AN...

Descripción completa

Detalles Bibliográficos
Autores principales: Ren, Ming-Han, Qi, Xing-Si, Chu, Yu-Ning, Yu, Ya-Nan, Chen, Yun-Qing, Zhang, Peng, Mao, Tao, Tian, Zi-Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940277/
https://www.ncbi.nlm.nih.gov/pubmed/32975685
http://dx.doi.org/10.1245/s10434-020-09153-7
_version_ 1783661918527946752
author Ren, Ming-Han
Qi, Xing-Si
Chu, Yu-Ning
Yu, Ya-Nan
Chen, Yun-Qing
Zhang, Peng
Mao, Tao
Tian, Zi-Bin
author_facet Ren, Ming-Han
Qi, Xing-Si
Chu, Yu-Ning
Yu, Ya-Nan
Chen, Yun-Qing
Zhang, Peng
Mao, Tao
Tian, Zi-Bin
author_sort Ren, Ming-Han
collection PubMed
description BACKGROUND: When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. PATIENTS AND METHODS: We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed. RESULTS: LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer. CONCLUSIONS: Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety.
format Online
Article
Text
id pubmed-7940277
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-79402772021-03-21 Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer Ren, Ming-Han Qi, Xing-Si Chu, Yu-Ning Yu, Ya-Nan Chen, Yun-Qing Zhang, Peng Mao, Tao Tian, Zi-Bin Ann Surg Oncol Gastrointestinal Oncology BACKGROUND: When the risk of lymph node metastasis (LNM) is considered minimal in patients with early gastric cancer (EGC), endoscopic submucosal dissection (ESD) is an effective alternative to radical resection. This study aims to estimate the feasibility of ESD for EGC with ulceration. PATIENTS AND METHODS: We retrospectively reviewed data from 691 patients who underwent gastrectomy for EGC with ulceration. Subsequently, a stratification system for lesions was created based on the expanded ESD criteria, and the associations between the subgroups and the rate of LNM were analyzed. RESULTS: LNM was confirmed in 16.5% (114/691) of patients. Univariate analysis demonstrated that age, sex, tumor size, macroscopic features, depth of invasion, tumor differentiation, Lauren type, lymphovascular invasion (LVI), and perineural invasion were associated with LNM. Multivariate analysis showed that LVI [odds ratio (OR) = 16.761, P < 0.001], SM1 invasion (OR = 2.159, P = 0.028), and SM2 invasion (OR = 3.230, P < 0.001) were independent risk factors for LNM. LNM occurred in undifferentiated mucosal tumors, with ulceration being 1.7% (2/116) when the lesion was smaller than 20 mm. Further stratification revealed that among lesions < 30 mm in size, undifferentiated tumors with SM1 invasion had a higher rate of LNM and a lower disease-free survival rate than differentiated tumors with SM1 invasion and tumors limited to the mucosal layer. CONCLUSIONS: Depth of invasion and LVI were strongly associated with LNM in ulcerative EGC. Endoscopic resection may be applicable for undifferentiated mucosal ulcerative EGC < 30 mm in size, and additional investigation is needed to evaluate its safety. Springer International Publishing 2020-09-25 2021 /pmc/articles/PMC7940277/ /pubmed/32975685 http://dx.doi.org/10.1245/s10434-020-09153-7 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Gastrointestinal Oncology
Ren, Ming-Han
Qi, Xing-Si
Chu, Yu-Ning
Yu, Ya-Nan
Chen, Yun-Qing
Zhang, Peng
Mao, Tao
Tian, Zi-Bin
Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title_full Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title_fullStr Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title_full_unstemmed Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title_short Risk of Lymph Node Metastasis and Feasibility of Endoscopic Treatment in Ulcerative Early Gastric Cancer
title_sort risk of lymph node metastasis and feasibility of endoscopic treatment in ulcerative early gastric cancer
topic Gastrointestinal Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940277/
https://www.ncbi.nlm.nih.gov/pubmed/32975685
http://dx.doi.org/10.1245/s10434-020-09153-7
work_keys_str_mv AT renminghan riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT qixingsi riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT chuyuning riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT yuyanan riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT chenyunqing riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT zhangpeng riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT maotao riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer
AT tianzibin riskoflymphnodemetastasisandfeasibilityofendoscopictreatmentinulcerativeearlygastriccancer