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Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer

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Abstract

Background

Although surgery is recommend for non-curative endoscopic resection of early gastric cancer (EGC), only a part of patients are found to have lymph node (LN) metastasis. This study aimed to identify the predictors of LN metastasis in patients with non-curative endoscopic resection.

Methods

Between April 2005 and July 2013, consecutive patients who received non-curative endoscopic resection and then underwent gastrectomy with lymphadenectomy or followed at least 1 year with abdominal computed tomography were retrospectively enrolled at a single tertiary hospital. Non-curative resection was defined as a resection beyond the expanded criteria in pathologic mapping. The predictors for LN metastasis were identified by fitting a multivariate logistic regression model.

Results

Among the 1783 consecutive patients who received endoscopic resection of EGC, non-curative resection was performed in 323 (18.1 %) patients. Of these patients, a total of 267 patients were enrolled, and the rate of LN metastasis was 6.7 % (18/267). In multivariate analysis, venous invasion [odds ratio (OR), 7.83; 95 % confidence interval (CI) 2.20–27.86; p = 0.001], sm2 invasion (tumor invasion ≥500 µm into submucosa; OR 4.98; 95 % CI 1.34–18.47; p = 0.016), or antral tumor location (OR 12.65; 95 % CI 1.57–102.00; p = 0.017) were independent predictors for LN metastasis. The rates of LN metastasis were 1.1 % (95 % CI 0–2.7) for patients with one or no predictor and 17.8 % (95 % CI 9.7–25.8) for those with two or more predictors.

Conclusions

Additional gastrectomy with lymphadenectomy after non-curative endoscopic resection of EGC is recommended for the patients with two or more identified predictors. However, close follow-up without immediate surgery might be considered cautiously for those with only one or no predictor.

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Acknowledgments

This work was supported by a Grant from the Liver Research Institute, Seoul National University College of Medicine.

Disclosures

Drs. Hyo-Joon Yang, Sang Gyun Kim, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Woo Ho Kim, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea

    Hyo-Joon Yang, Sang Gyun Kim, Joo Hyun Lim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim & Hyun Chae Jung

  2. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    Woo Ho Kim

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  1. Hyo-Joon Yang
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Correspondence to Sang Gyun Kim.

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Yang, HJ., Kim, S.G., Lim, J.H. et al. Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer. Surg Endosc 29, 1145–1155 (2015). https://doi.org/10.1007/s00464-014-3780-7

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  • DOI: https://doi.org/10.1007/s00464-014-3780-7

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