Predictors of lymph node metastasis in patients with non-curative endoscopic resection of early gastric cancer
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.
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.
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.
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.
KeywordsEarly gastric cancer Non-curative endoscopic resection Lymph node metastasis Predictor
- 2.The information committee of the Korean Gastric Cancer Association (2007) 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 7:47–54Google Scholar
- 5.Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235CrossRefPubMedGoogle Scholar
- 12.Ito H, Inoue H, Ikeda H, Odaka N, Yoshida A, Satodate H, Onimaru M, Takayanagi D, Santi EG, Kudo SE (2013) Surgical outcomes and clinicopathological characteristics of patients who underwent potentially noncurative endoscopic resection for gastric cancer: a report of a single-center experience. Gastroenterol Res Pract 2013:427405CrossRefPubMedCentralPubMedGoogle Scholar
- 13.Son SY, Park JY, Ryu KW, Eom BW, Yoon HM, Cho SJ, Lee JY, Kim CG, Lee JH, Kook MC, Choi IJ, Kim YW (2013) The risk factors for lymph node metastasis in early gastric cancer patients who underwent endoscopic resection: is the minimal lymph node dissection applicable? A retrospective study. Surg Endosc 27:3247–3253CrossRefPubMedGoogle Scholar
- 14.Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, Lee HJ, Kim MC, Korean Laparoscopic Gastrointestinal Surgery Study G (2008) Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol 98:6–10CrossRefPubMedGoogle Scholar
- 20.Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system, 4th edn. International Agency for Research on Cancer, LyonGoogle Scholar
- 29.Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ, Korean Laparoscopic Gastrointestinal Surgery Study G (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15:2692–2700CrossRefPubMedGoogle Scholar